title: Laparoscopic pyloromyotomy: Lessons learnt in our first 101 cases.
abstract: OBJECTIVE
  To analyze our experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis for the lessons that we learnt and to study the effect of learning curve.
  
  
  METHODS
  This is a retrospective analysis of case records of 101 infants who underwent laparoscopic pyloromyotomy over 6 years. The demographic characteristics, conversion rate, operative time, complications, time to first feed and post-operative hospital stay were noted. The above parameters were compared between our early cases (2007-2009) (n = 43) and the later cases (2010-2013) (n = 58).
  
  
  RESULTS
  89 male and 12 female babies ranging in age from 12 days to 4 months (mean: 43.4 days) were operated upon during this period. The babies ranged in weight from 1.8 to 4.7 kg (mean: 3.1 kg). Four cases were converted to open (3.9%): three due to mucosal perforations and one due to technical problem. The mean operative time was 45.7 minutes (49.7 minutes in the first 3 years and 43.0 minutes in the next 3 years). There were 10 complications-4 mucosal perforations, 5 inadequate pyloromyotomies and 1 omental prolapse through a port site. All the complications were effectively handled with minimum morbidity. In the first 3 years of our experience the conversion rate was 9.3%, mucosal perforations were 6.9% and re-do rate was 2.3% as compared to 0%, 1.7% and 6.9%, respectively, in the next 3 years. Mean time for starting feeds was 21.4 hours and mean post-operative hospital stay was 2.4 days.
  
  
  CONCLUSIONS
  Laparoscopic pyloromyotomy is a safe procedure with minimal morbidity and reasonable operative times. Conversion rates and operative times decrease as experience increases. Our rate of inadequate pyloromyotomy was rather high which we hope to decrease with further experience.
authors.affiliation: Department of Surgery, Bharti Hospital and Research Centre, Pune, Maharashtra, India.
authors.forename: Abhilasha Tej
authors.initials: AT
authors.lastname: Handu
authors.affiliation: Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Jadhav
authors.affiliation: Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.
authors.forename: J
authors.initials: J
authors.lastname: Deepak
authors.affiliation: Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.
authors.forename: Jayalaxmi S
authors.initials: JS
authors.lastname: Aihole
authors.affiliation: Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.
authors.lastname: Gowrishankar
authors.affiliation: Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.
authors.forename: M
authors.initials: M
authors.lastname: Narendrababu
authors.affiliation: Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.
authors.forename: S
authors.initials: S
authors.lastname: Ramesh
authors.affiliation: Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.
authors.forename: Kr
authors.initials: K
authors.lastname: Srimurthy
keywords: Infantile hypertrophic pyloric stenosis; laparoscopy; pyloromyotomy