Single-incision laparoscopic pyloromyotomy: Initial experience

Background Laparoscopic pyloromyotomy has become the standard treatment for hypertrophic pyloric stenosis. Single-incision laparoscopic surgery is an emerging operative approach that utilizes the umbilical scar to hide the surgical incision. Objective To describe our initial experience with singleincision laparoscopic pyloromyotomy in 15 infants. Materials and methods Laparoscopic pyloromyotomy was performed through a single skin incision in the umbilicus, using a 4-mm 30° endoscope and a 5-mm trocar. The 3-mm working instruments were inserted directly into the abdomen via separate lateral fascial stab incisions. All patients were prospectively evaluated. Results The procedure was performed in 15 infants (13 male) with mean age of 45 ± 16 days and mean weight of 4.04 ± 0.5 kg. All procedures were completed laparoscopically, and one case was converted to a conventional triangulated laparoscopic work configuration after a mucosal perforation was noted. The perforation was repaired laparoscopically. On average, operating time was 29.8 ± 13.6 min, and postoperative length of stay was 1.5 ± 0.8 days. All patients were discharged home on full feeds. Follow-up was scheduled 2-3 weeks after discharge, and no postoperative complications were noted in any of the patients. Conclusions Single-incision laparoscopic pyloromyotomy is a safe and feasible procedure with good postoperative results and excellent cosmesis. The main challenge is the spatial orientation of the instruments and endoscope in a small working space. This can be overcome by a more longitudinally oriented working axis than used in the conventional angulated laparoscopic configuration.