Med Bull Sisli Etfal Hosp. 2020; 54(3): 333-336 | DOI: 10.14744/SEMB.2018.16779

Our Experience with Laparoscopic Pyloromyotomy in Patients with Infantile Hypertrophic Pyloric Stenosis

Meltem Kaba, Cetin Ali Karadag, Mesut Demir, Nihat Sever, Aydin Unal, Melih Akýn, Ali Ihsan Dokucu
Department of Pediatric Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

Objectives: In this study, we aim to discuss our experience with laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis (IHPS) and skills development throughout our learning curve.
Methods: We retrospectively collected data from 15 patients with IHPS who underwent laparoscopic pyloromyotomy between 2016 and 2019 in our clinic. Evolution in operation techniques, peroperative and postoperative surgical complications were analysed.
Results: In this research, 15 patients (male-to-female ratio: 2.7/1) were studied. The median age at presentation was 36.5 days (25-100 days). Non-bilious projectile vomiting was seen in all of the patients, and in eight cases, marked failure to thrive was seen. Situs inversus totalis was seen in one of the cases as an associated anomaly, no other anomalies were noted. A palpable olive-shaped mass was found in only 33% of infants (five cases). A patient was detected to have no IHPS peroperatively. One of the cases was converted to open technique due to peroperative technical difficulties. A patient underwent 2nd operation due to incomplete pyloromyotomy. The duration of the first and last cases was 110 mins and 35 mins, respectively.
Conclusion: The laparoscopic approach in patients with infantile hypertrophic pyloric stenosis can result in good postoperative outcomes and satisfying surgery in the hands of surgeons who perform minimally invasive surgery routinely.

Keywords: Infantile hypertrophic pyloric stenosis, laparoscopy; minimal invasive surgery; pyloromyotomy.

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Ýnfantil Hipertrofik Pilor Stenozunda Laparoskopik Piloromiyotomi Deneyimlerimiz

Meltem Kaba, Cetin Ali Karadag, Mesut Demir, Nihat Sever, Aydin Unal, Melih Akýn, Ali Ihsan Dokucu
Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi Çocuk Cerrahisi Kliniði, Ýstanbul

Amaç: Ýnfantil hipertrofik pilor stenozunun (ÝHPS) tedavisinde laparaskopik piloromiyotomi ameliyatýndaki deneyimlerimiz doðrultusunda tekniðimizin gözden geçirilmesi ve sunulmasý amaçlanmýþtýr.
Gereç ve yöntem: Kliniðimizde Nisan 2016-Nisan 2018 tarihleri arasýnda laparaskopik piloromiyotomi uygulanan toplam 15 ÝHPS’li olgunun kayýtlarý geriye dönük olarak incelendi. Olgular kullanýlan laparaskopik teknikteki deðiþim, peroperatif ve postoperatif cerrahi komplikasyonlar açýsýndan deðerlendirildi.
Bulgular: Erkek-kýz oraný 2.7: 1 olan hastalarýn baþvuru yaþý 36.5 (25-110) gün idi. Tüm hastalarda fýþkýrýr tarzda þiddetli safrasýz kusma ve 8 olguda ise belirgin kilo alamama þikayeti saptandý. Hastalarýn bir tanesinin situs inversus totalis olmasý dýþýnda ek týbbi durum saptanmadý. Bir hastanýn peroperatif olarak pilor stenozu olmadýðý anlaþýldý. Bir hasta yetersiz piloromiyotomi tanýsý ile tekrar opere edildi. Bir hastada peroperatif teknik zorluk nedeniyle açýk ameliyata dönüldü. Ýlk laparaskopik piloromiyotomi vakasýnýn ameliyat süresi 110 dakika iken serideki son ameliyatýn süresi 35 dakika olarak kayýt edildi.
Sonuç: Ýnfantil hipertrofik pilor stenozu cerrahisinde laparaskopik yaklaþým, minimal invaziv cerrahiyi rutin uygulamakta olan cerrahlar için, hýzlý bir öðrenme eðrisi ile iyi sonuçlara ve tatmin edici bir cerrahiye dönüþmektedir. (SETB-2018-07-097)

Anahtar Kelimeler: Ýnfantil hipertrofik pilor stenozu, laparoskopi; piloromiyotomi; minimal invaziv cerrahi.

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