Laparoscopic Pyloromyotomy: Learning Curve
Kedar P Mudkhedkar, Sandesh V Parelkar, Beejal V Sanghavi, Rahul K Gupta, Satej Mhaskar, Kavimozhi Ilakkiya
INTRODUCTION: Infantile hypertrophic pyloric stenosis (IHPS) is one of the many causes of recurrent gastric vomiting in infants, the incidence of which is approximately 1 to 3 per 1,000 live births. Laparoscopic pyloromyotomy (LP) is becoming increasingly popular as the standard treatment for hypertrophic pyloric stenosis. MATERIALS AND METHODS: We describe our experience with LP in 50 infants over a period of 7 years divided into two groups, with the first being first 3 years and the second being next 4 years. The LP was performed through 5-mm umbilical port with 5-mm 30 endoscope. Two 3-mm working instruments were inserted directly into the abdomen via separate lateral incisions. RESULTS: All patients were retrospectively evaluated. The procedure was performed in 50 infants with a mean age of 38 days and mean weight of 3.1 kg. All procedures, except two, were completed laparoscopically. Average operating time was 28 minutes in group I, while it was 21.44 min in group II (p-value <0.001). There were no major intraoperative and postoperative complications. CONCLUSION: The LP has already been shown to be feasible, safe, effective, and with reduction in incision size. We further find that LP has a definite learning curve and as experience is gained, operative time decreases. In our study, we also found time to feed also decreased significantly.
Infantile hypertrophic pyloric stenosis, Laparoscopic pyloromyotomy, Learning curve.