Pyloromyotomy: a comparison of laparoscopic, circumumbilical, and right upper quadrant operative techniques.
J Am Coll Surg
; 201(1): 66-70, 2005 Jul.
Article
em En
| MEDLINE
| ID: mdl-15978445
ABSTRACT
BACKGROUND:
Ramstedt pyloromyotomy through a right upper quadrant (RUQ) transverse incision has been the traditional treatment for hypertrophic pyloric stenosis. Recently, laparoscopic (LAP) and circumumbilical (UMB) approaches have been introduced as alternative methods to improve cosmesis, but concerns about greater operative times, costs, and complications remain. This study compares the three operative techniques and examines their advantages and complication rates. STUDYDESIGN:
We performed a retrospective review of patients undergoing pyloromyotomy at a children's hospital between January 1997 and June 2003.RESULTS:
Two hundred ninety patients underwent pyloromyotomy by LAP (n = 51), RUQ (n = 190), or UMB (n = 49). Complication rate, time to ad libitum feeding, incidence of emesis, and postoperative length of stay did not differ considerably among groups. Two LAP patients were converted to RUQ. Mucosal perforation occurred in three patients each in the RUQ and UMB groups, but none in the LAP group. Operative times were considerably less for LAP (25 +/- 9 minutes) than for RUQ (32 +/- 9 minutes) and UMB (42 +/- 12 minutes) (p < 0.05, ANOVA, Bonferroni). Charges related to operations and anesthesia were considerably greater for UMB (operation US 1,574 dollars +/- US 433 dollars; anesthesia US 731 dollars +/- US 190 dollars) compared with the other two groups (p < 0.05, ANOVA, Bonferroni), but did not differ between LAP (operation US 1,299 dollars +/- US 311 dollars; anesthesia US 586 dollars +/- US 137 dollars) and RUQ (operation US 1,237 dollars +/- US 411 dollars; anesthesia US 578 dollars +/- US 167 dollars). Data are presented as mean +/- SD.CONCLUSIONS:
Advantages of LAP include a shorter mean operative time without higher complications or costs. UMB is associated with the greatest mean operative time and costs. Laparoscopic pyloromyotomy is a safe and effective approach to the treatment of hypertrophic pyloric stenosis.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Piloro
/
Umbigo
/
Laparoscopia
/
Estenose Pilórica Hipertrófica
/
Abdome
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Infant
/
Male
Idioma:
En
Revista:
J Am Coll Surg
Assunto da revista:
GINECOLOGIA
/
OBSTETRICIA
Ano de publicação:
2005
Tipo de documento:
Article
País de afiliação:
Estados Unidos