Laparoscopic Pyloromyotomy an Alternative to Periumbilical Pyloromyotomy

Background: Infantile hypertrophic pyloric stenosis (IHPS) is a common pediatric surgical condition. Conventional surgical management as described by Ramstedt has been the procedure of choice for decades; this approach was modified by an upper periumbilical incision. Since Alain et al., introduced the technique for pyloromyotomy by laparoscopy; this minimal access approach has gained much popularity. Aim of the work: The purpose of this study was to evaluate the utility of periumbilical pyloromyotomy (PP) for IHPS compared to laparoscopic pyloromyotomy (LP). Patients and methods: Over a period of 3 years 36 babies with IHPS were treated at the pediatric surgical unit of Ain Shams University, they were divided into two groups; Group 1 (PP); 19 babies, underwent periumbilical pylomyotomy and Group 2 (LP); 17 babies were treated laparoscopically. The 2 groups were compared as regard sex, age, body weight at the time of admission, duration of vomiting before admission, pyloric muscle length and thickness on ultrasonography (US), operative time, time taken to restart feeding, time taken to achieve full feeding, incidence of postoperative emesis associated with feeding and postoperative surgical complications. Results: The preoperative hospital records of the babies were more or less similar in the two groups. Initially the operating time was significantly shorter in PP group, but later in the study after mastering the laparoscopic technique LP became significantly shorter than the PP group. There were neither incomplete pyloromyotomy, nor incisional hernia in both group. Two babies in LP group had duodenal perforation and operation converted to open technique. Time taken to achieve full feeding in the LP group was shorter than the PP group. Two patients in PP group developed postoperative vomiting versus one patient in LP group. The length of hospitalization was shorter in the LP group. Wound abscess occurred in I baby in PP group and drained locally. Conclusion: The open and laparoscopic approaches have similar overall complication rates. The distribution and the type of complications differ, however. Laparoscopic pyloromyotomy is a reliable alternative to open pyloromyotomy.