The value of laparoscopic pyloromyotomy for the treatment of hypertrophic pyloric stenosis is unclear.
In this study, doctors from the Netherlands assessed the influence of experience with laparoscopic pyloromyotomy on operative time, complication rate, and postoperative hospital stay.
The team assessed 182 children who underwent laparoscopic pyloromyotomy for hypertrophic pyloric stenosis between 1993 and 2002.
The procedures involved 11 surgeons, 4 consultants, and 7 trainees.
The doctors measured operative time, complications, and postoperative hospital stay.
|Length of postoperative hospital stay dropped with increasing experience.|
They also compared the outcomes of 146 laparoscopic pyloromyotomies performed after July 1996 with laparoscopic pyloromyotomies performed before that date.
The doctors did not identify a significant difference in the mean operative time between the 2 series. However, they did find that operative time per surgeon dropped with experience.
The team found that mucosal perforation occurred in 8% of the initial series, compared with 0.7% in the later series.
In addition, insufficient pyloromyotomy occurred in 8% of the initial series, compared with 3% of the later series.
The doctors found that the procedure was easily learned by novices, and after about 15 pyloromyotomies, the operative time was approximately 25 minutes.
The length of postoperative hospital stay also dropped with increasing experience.
Dr van der Bilt and colleagues concluded, “The value of laparoscopic pyloromyotomy for the treatment of hypertrophic pyloric stenosis has been proved“.
“The laparoscopic pyloromyotomy procedure is as quick as the open procedure, has a low morbidity, and is devoid of major wound-related problems“.