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The Cross-technique for single-incision pediatric endosurgical pyloromyotomy

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Abstract

Background

Single-incision pediatric endosurgical (SIPES) pyloromyotomy is frequently used for the treatment of hypertrophic pyloric stenosis at our center. Our initial SIPES approach mirrored the conventional, triangulated laparoscopic pyloromyotomy. Because an increased number of perforations were noted on our initial analysis, a more straightforward Cross-technique SIPES pyloromyotomy was developed. This study compares the current Cross-technique SIPES pyloromyotomy to the previous standard SIPES operation.

Methods

The Cross-technique entails grasping the antrum with the surgeon’s left hand instrument, retracting toward the left lower quadrant, and thereby orienting the pylorus obliquely toward the right upper quadrant. The serosal incision and muscular spreading is accomplished using a right-hand instrument that crosses over the left hand grasper. Demographic variables, operative times, estimated blood loss (EBL), complications, conversion rate, and postoperative length of stay were compared.

Results

Twenty-nine Cross-technique patients were compared with 23 in the standard group. The Cross-technique was faster than the standard procedure (21 ± 5 vs. 27 ± 12 min, p = 0.03) and EBL was lower (1.3 ± 0.5 vs. 1.7 ± 0.6 ml, p = 0.02). There were two mucosal perforations requiring conversions to triangulated 3-access-site laparoscopy in the standard, and one conversion to open surgery in the Cross-technique group. Patients who underwent cross-technique pyloromyotomy weighed less (3.6 ± 0.6 vs. 4.0 ± 0.5 kg, p = 0.012), but there were no differences in age, gender ratio, conversion rate, or length of stay. There was one postoperative wound infection in the cross-technique, but none in the standard group. No patients required reoperation. All participating surgeons felt that the cross-technique was more ergonomic and easier to perform than the standard SIPES technique.

Conclusions

The Cross-technique appears superior to standard SIPES pyloromyotomy and should be preferentially used for single-incision endosurgical pyloromyotomy for hypertrophic pyloric stenosis.

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Disclosures

Drs. Muensterer, Chong, Georgeson and Harmon have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA

    Oliver J. Muensterer, Albert J. Chong, Keith E. Georgeson & Carroll M. Harmon

  2. Division of Pediatric Surgery, Weill Cornell Medical College, 525 East 68th Street, Box 209, New York, 10021, USA

    Oliver J. Muensterer

Authors
  1. Oliver J. Muensterer
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  2. Albert J. Chong
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  3. Keith E. Georgeson
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  4. Carroll M. Harmon
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Corresponding author

Correspondence to Oliver J. Muensterer.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Description of Cross-technique SIPES pyloromyotomy (WMV 5638 kb)

Alternative use of the paddle-tip electrocautery to perform the serosal incision (WMV 2239 kb)

Postoperative outcome 2 to 3 weeks after the procedure (WMV 2356 kb)

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Muensterer, O.J., Chong, A.J., Georgeson, K.E. et al. The Cross-technique for single-incision pediatric endosurgical pyloromyotomy. Surg Endosc 25, 3414–3418 (2011). https://doi.org/10.1007/s00464-011-1677-2

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  • DOI: https://doi.org/10.1007/s00464-011-1677-2

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