Surgical Endoscopy

, Volume 24, Issue 7, pp 1589–1593

Single-incision laparoscopic pyloromyotomy: initial experience

  • Oliver J. Muensterer
  • Obinna O. Adibe
  • Carrol M. Harmon
  • Albert Chong
  • Erik N. Hansen
  • Donna Bartle
  • Keith E. Georgeson



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.


To describe our initial experience with single-incision 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.


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.


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.


Pyloromyotomy Single incision Laparoscopy Infant 


  1. 1.
    Tracy CR, Raman JD, Cadeddu JA, Rane A (2008) Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol 5:561–568CrossRefPubMedGoogle Scholar
  2. 2.
    Canes D, Desai MM, Aron M et al (2008) Transumbilical single-port surgery: evolution and current status. Eur Urol 54:1020–1029CrossRefPubMedGoogle Scholar
  3. 3.
    Hong TH, Kim HL, Lee YS et al (2009) Transumbilical single-port laparoscopic appendectomy (TUSPLA): scarless intracorporeal appendectomy. J Laparoendosc Adv Surg Tech A 19:75–78CrossRefPubMedGoogle Scholar
  4. 4.
    Chamberlain RS, Sakpal SV (2009) A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy. J Gastrointest Surg [Epub ahead of print]Google Scholar
  5. 5.
    Kaouk JH, Palmer JS (2008) Single-port laparoscopic surgery: initial experience in children for varicocelectomy. BJU Int 102:97–99CrossRefPubMedGoogle Scholar
  6. 6.
    Alain JL, Grousseau D, Terrier G (1991) Extramucosal pyloromyotomy by laparoscopy. Surg Endosc 5:174–175CrossRefPubMedGoogle Scholar
  7. 7.
    Haricharan RN, Aprahamian CJ, Morgan TL et al (2008) Smaller scars–what is the big deal: a survey of the perceived value of laparoscopic pyloromyotomy. J Pediatr Surg 43:92–96CrossRefPubMedGoogle Scholar
  8. 8.
    Kim SS, Lau ST, Lee SL et al (2005) Pyloromyotomy: a comparison of laparoscopic, circumumbilical, and right upper quadrant operative techniques. J Am Coll Surg 201:66–70CrossRefPubMedGoogle Scholar
  9. 9.
    St Peter SD, Holcomb GW 3rd, Calkins CM et al (2006) Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg 244:363–370PubMedGoogle Scholar
  10. 10.
    Ramstedt C (1912) Zur Operation der angeborenen Pylorusstenose. Medizinische Klinik 8:1702–1705Google Scholar
  11. 11.
    Tan KC, Bianchi A (1986) Circumumbilical incision for pyloromyotomy. Br J Surg 73:399CrossRefPubMedGoogle Scholar
  12. 12.
    Adibe OO, Nichol PF, Flake AW, Mattei P (2006) Comparison of outcomes after laparoscopic and open pyloromyotomy at a high-volume pediatric teaching hospital. J Pediatr Surg 41:1676–1678CrossRefPubMedGoogle Scholar
  13. 13.
    Romanelli JR, Mark L, Omotosho PA (2008) Single port laparoscopic cholecystectomy with the TriPort system: a case report. Surg Innov 15:223–228CrossRefPubMedGoogle Scholar
  14. 14.
    Merchant AM, Cook MW, White BC et al (2009) Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg 13:159–162CrossRefPubMedGoogle Scholar
  15. 15.
    Ibarguen-Secchia E (2005) Endoscopic pyloromyotomy for congenital pyloric stenosis. Gastrointest Endosc 61:598–600CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Oliver J. Muensterer
    • 1
  • Obinna O. Adibe
    • 1
  • Carrol M. Harmon
    • 1
  • Albert Chong
    • 1
  • Erik N. Hansen
    • 1
  • Donna Bartle
    • 1
  • Keith E. Georgeson
    • 1
  1. 1.Department of Pediatric Surgery, Children’s Hospital of AlabamaUniversity of Alabama at BirminghamBirminghamUSA

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