Single-incision laparoscopic pyloromyotomy: initial experience.
BACKGROUND
Laparoscopic pyloromyotomy has become the standard treatment for hypertrophic pyloric stenosis. Single-incision laparoscopic surgery is an emerging operative approach that utilizes the umbilical scar to hide the surgical incision.


OBJECTIVE
To describe our initial experience with single-incision laparoscopic pyloromyotomy in 15 infants.


METHODS
Laparoscopic pyloromyotomy was performed through a single skin incision in the umbilicus, using a 4-mm 30 degrees endoscope and a 5-mm trocar. The 3-mm working instruments were inserted directly into the abdomen via separate lateral fascial stab incisions. All patients were prospectively evaluated.


RESULTS
The procedure was performed in 15 infants (13 male) with mean age of 45 +/- 16 days and mean weight of 4.04 +/- 0.5 kg. All procedures were completed laparoscopically, and one case was converted to a conventional triangulated laparoscopic work configuration after a mucosal perforation was noted. The perforation was repaired laparoscopically. On average, operating time was 29.8 +/- 13.6 min, and postoperative length of stay was 1.5 +/- 0.8 days. All patients were discharged home on full feeds. Follow-up was scheduled 2-3 weeks after discharge, and no postoperative complications were noted in any of the patients.


CONCLUSIONS
Single-incision laparoscopic pyloromyotomy is a safe and feasible procedure with good postoperative results and excellent cosmesis. The main challenge is the spatial orientation of the instruments and endoscope in a small working space. This can be overcome by a more longitudinally oriented working axis than used in the conventional angulated laparoscopic configuration.
Muensterer
Oliver J
OJ
Department of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South ACC 300, Birmingham, AL 35233, USA. oliver.muensterer@ccc.uab.edu
Adibe
Obinna O
OO
Harmon
Carrol M
CM
Chong
Albert
A
Hansen
Erik N
EN
Bartle
Donna
D
Georgeson
Keith E
KE
D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*