Purpose: To assess in a prospective manner three laparoscopic pyloromyotomy techniques in order to find the most suitable one in regards to short term outcomes.
Patients & Methods: Forty infants with IHPS were treated along the last 30 months. All cases were subjected to laparoscopic pyloromyotomy. Babies less than 3 days or Infants more than 3 months were excluded from the current study. Cases will be evaluated for operative time, surgeon’s satisfaction and any operative complication. The umbilical port position and Rt hypochondrial port are fixed while change is in others.
Results: We have 40 cases with age ranged between 15 and 42 days. Ten cases managed by Tan’s approach, 13 cases by Marven’s approach and 17 by modified Marven’s approach. Seromuscular incision is done in all cases using myringotomy knife. Operative time ranged between 15 and 50 min (30 and 50 min in Tan’s, 20 and 45 min in Marven’s and 15 and 40 min in modified Marven’s), with one conversion. We observed more difficulty in Tan’s approach as the incision is not direct over the mass as compared to modified Marven’s with better fixation. Post operatively; vomiting is reported to be higher in Tan’s subgroup, better cosmesis in Marven’s subgroup despite no statistical significances. Two cases of recurrent vomiting; one with incomplete pyloromyotomy in the early learning curve in Tan’s subgroup and the other with missed complete Ladd’s band where both managed operatively.
Conclusion: Laparoscopic pyloromyotomy is an excellent technique in IHPS cases with superior cosmesis, technique is feasible and safe. Modified Marven’s approach showed the best outcome in our study. Experience of the whole team is a must and larger numbers are needed to make the real validation of results in evidence based warranty.
Keywords: Pyloromyotomy, MIS, Laparoscopic Pyloromyotomy, Myringotomy knife
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