An Easy and Safe Technique for Laparoscopic Pyloromyotomy: Using a Vascular Clamp for Stabilization of the Pylorus.

ABSTRACT

BACKGROUND: Laparoscopic pyloromyotomy (LP) is a well-established approach for treating hypertrophic pyloric stenosis. Although grasping the pylorus with forceps is important in LP, it requires a high level of surgical skill. To make this approach easier, in 2008 we introduced the method of Dozier and Kim, in which a vascular clamp (VC) is used for grasping the pylorus (LP with VC). Here, we retrospectively compared results between traditional LP (TLP) and LP with VC. MATERIALS AND METHODS: Forty-three patients underwent LP with VC, whereas 194 patients underwent TLP. Two ports in the umbilicus and the left flank are common in both procedures. Instead of a right flank port, however, in LP with VC, we directly insert a VC to grasp the pylorus. RESULTS: Patients' characteristics were not different between the two groups. There was only one wound infection and no major complication associated with LP with VC, whereas there were three major complications in TLP. Our hospital is a pediatric teaching institution in Japan where many surgeons perform their first LP. Twenty-eight surgeons performed their first LP in our hospital in the past 17 years, and LP with VC was the first LP for nine. The operative time for surgeons' first LP was significantly shorter with LP with VC than with TLP, based on Welch's t test (42.8 versus 54.4 minutes; P = .048). CONCLUSIONS: Our results suggest that LP with VC is an easy and safe technique, and it is recommended for beginners in laparoscopic surgery.