title: Laparoscopic pyloromyotomy: is a knife really necessary?
abstract: BACKGROUND
  Laparoscopic pyloromyotomy (LP) is currently accepted as a suitable treatment modality for infantile hypertrophic pyloric stenosis (IHPS). In this report, we describe some technical modifications of LP using a 3- or 5-mm hook with electrocautery as a substitute for a knife for incising the pylorus. The outcomes of LP using a standard retractable pyloromyotomy knife are compared with those of LP using a hook electrocautery.
  
  
  METHODS
  The patients with ultrasound proven IHPS who had undergone LP in a single institution from December 2008 to April 2010 were retrospectively analyzed. Incision on the pylorus was made with a 3-mm pyloromyotomy knife in the initial 12 cases. However, in the latter part of the study, a 3- or 5-mm hook with electrocautery was used for the incision. A Maryland dissector was used for completing the pyloromyotomy. The results were compared in terms of duration of surgery, complications, time taken to establish the first full feed, requirement of analgesics, postoperative emesis, and postoperative stay in the hospital. Independent sample t test and the Chi-square test were used for statistical analysis.
  
  
  RESULTS
  Of the 27 patients analyzed, 12 underwent LP using a pyloromyotomy knife and the remaining 15 patients were operated on using a hook with electrocautery instead of the knife. The operating time, time taken to establish the first full feed, and duration of hospital stay were comparable among the two groups with no statistically significant difference. No complications were recorded in either group.
  
  
  CONCLUSIONS
  Use of hook electrocautery for incising the pylorus provides a bloodless field without affecting the postoperative recovery and outcome. It also obviates any need of specialized instruments like a pyloromyotomy knife or other sharp instruments for pyloric incision.
authors: Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, 110001, India. dr.vishesh79@gmail.com
authors: Vishesh
authors: V
authors: Jain
authors: Subhasis Roy
authors: SR
authors: Choudhury
authors: Rajiv
authors: R
authors: Chadha
authors: Archana
authors: A
authors: Puri
authors: Abhimanyu Singh
authors: AS
authors: Naga
mesh_terms: D000465:Algorithms; D004564:Electrocoagulation / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000295:instrumentation; D008297:Male; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome