title: Can a simplified algorithm prevent incomplete laparoscopic pyloromyotomy?
abstract: OBJECTIVE
  The purpose of this study is to analyze an algorithm intended to prevent incomplete pyloromyotomy in 3-port laparoscopic (3TP) and laparoendoscopic single-site (LESS-P) procedures in a teaching hospital.
  
  
  METHODS
  We defined the pyloroduodenal and pyloroantral junctions as anatomical margins prior pyloromyotomy by palpating and coagulating the serosa with the hook cautery instrument. Incomplete pyloromyotomies, mucosa perforations, serosa lacerations, and wound infections were recorded for pediatric surgical trainees (PST) and board-certified pediatric surgeons (BC).
  
  
  RESULTS
  We reviewed the medical files of 233 infants, who underwent LESS-P (n=21), 3TP (n=71), and open pyloromyotomy (OP, n=141). No incomplete pyloromyotomies occurred. In contrast to OP, mucosa perforations did not occur in the laparoscopic procedures during the study period (6.38% vs. 0%, P=.013). OP had insignificantly more serosal lacerations (3.5% vs. 1.4%, P=.407). There was no difference in the rate of wound infections between OP and laparoscopic procedures (2.8% vs. 4.3%, P=.715). In the latter, all wound infections were associated with the use of skin adhesive.
  
  
  CONCLUSIONS
  This algorithm helps avoiding incomplete laparoscopic pyloromyotomy during the learning curve and in a teaching setting. It is not risky to assist 3TP and LESS-P to PST as this led to a decreased rate of mucosa perforations without experiencing incomplete pyloromyotomies.
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology Kliniken der Stadt Köln GmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735 Koeln, Germany. Electronic address: rvahdad@aol.com.
authors.forename: M Reza
authors.initials: MR
authors.lastname: Vahdad
authors.affiliation: Department of Pediatric Surgery, Marienhospital Herne, Ruhr-University of Bochum, Widumerstr. 8, 44627 Herne, Germany. Electronic address: matthias.nissen@marienhospital-herne.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Nissen
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology Kliniken der Stadt Köln GmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735 Koeln, Germany. Electronic address: alexander.semaan@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Semaan
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology Kliniken der Stadt Köln GmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735 Koeln, Germany. Electronic address: kleint@kliniken-koeln.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Klein
authors.affiliation: Department of Surgery, University Hospital Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. Electronic address: emanuel.palade@uksh.de.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Palade
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology Kliniken der Stadt Köln GmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735 Koeln, Germany. Electronic address: boemerst@kliniken-koeln.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Boemers
authors.affiliation: Department of Pediatric Surgery, Marienhospital Herne, Ruhr-University of Bochum, Widumerstr. 8, 44627 Herne, Germany. Electronic address: ralf-bodo.troebs@marienhospital-herne.de.
authors.forename: Ralf-Bodo
authors.initials: RB
authors.lastname: Troebs
authors.affiliation: Department of Pediatric Surgery, University Hospital Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. Electronic address: grigorec@hotmail.com.
authors.forename: Grigore
authors.initials: G
authors.lastname: Cernaianu
mesh_terms: D000465:Algorithms; D003661:Decision Support Techniques; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011707:Pyloric Stenosis / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D016896:Treatment Outcome
keywords: Child; Complications; Incomplete laparoscopic pyloromyotomy; LESS; Trainee