Laparoscopic Pyloromyotomy Research Articles

LAPAROSCOPIC EXPLORATION FOR INFANTILE HYPERTROPHIC PYLORIC STENOSIS: AN EXPERIENCE AT TERTIARY CARE HOSPITAL

Objectives: This study aims to share our experience of laparoscopic exploration for infantile hypertrophic pyloric stenosis. Material and methods: This retrospective study was conducted in the Department of Pediatric Surgery, Khyber Teaching Hospital, Peshawar from June 2017 to July 2020. This study includes all patients whose diagnosis of infantile hypertrophic pyloric stenosis (IHPS) was confirmed through ultrasound parameters and laparoscopic pyloromyotomy was performed. Data was retrieved from the laparoscopic surgery record. Retrieved data was tabulated and fed in SPSS 25 for analysis. Results: This study included 42 patients with a mean age of 50.28 ±18.5days and a mean weight of 3.35±0.76 kg. Male patients were 57 % while females were 43 %. The mean time to resuscitate the patient pre-operatively was 34.6±15.4 hours while the mean postoperative hospital stay was 45±12.47 hours. The mean operative time was 31.6±10.4 min. Operative time decreased with time depicting improvement in our learning curve (p=0.004). The method of working instrument placement had no impact on operative time (p=0.337). Meantime to full oral feed was 9.7±5.1 hours. We did not encounter mucosal perforation or incomplete myotomy. No surgery was converted to open. Conclusion: Laparoscopic pyloromyotomy is a safe and effective method of treatment for infantile hypertrophic pyloric stenosis. Keywords: laparoscopic pyloromyotomy, pyloric stenosis, IHPS

How Many Operative Performance Ratings Does a Pediatric Surgery Fellow Need to Be Deemed Practice Ready?

PurposeIdentifying the number of cases required for a fellow to achieve competence has been challenging. Workplace-based assessment (WBA) systems make collecting performance data practical and create the opportunity to translate WBA ratings into probabilistic statements about a fellow's likelihood of performing to a given standard on a subsequent assessment opportunity. MethodsWe compared data from two pediatric surgery training programs that used the performance rating scale from the Society for Improving Medical Professional Learning (SIMPL). We used a Bayesian generalized linear mixed effects model to examine the relationship past and future performance for three procedures: Laparoscopic Inguinal Hernia Repair, Laparoscopic Gastrostomy Tube Placement, and Pyloromyotomy. ResultsFor site one, 26 faculty assessed 9 fellows on 16 procedures yielding 1094 ratings, of which 778 (71%) earned practice-ready ratings. For site two, 25 faculty rated 3 fellows on 4 unique procedures yielding 234 ratings of which 151 (65%) were deemed practice-ready. We identified similar model-based future performance expectations, with prior practice-ready ratings having a similar average effect across both sites (Site one, B = 0.25; Site two, B = 0.25). Similar prior practice-ready ratings were needed for Laparoscopic G-Tube Placement (Site one = 13; Site two = 14), while greater differences were observed for Laparoscopic Inguinal Hernia Repair (Site one = 10; Site two = 15) and Pyloromyotomy (Site one = 10; Site two = 15). ConclusionOur approach to modeling operative performance data is effective at determining future practice readiness of pediatric surgery fellows across multiple faculty and fellow groups. This method could be used to establish minimum case number requirements. Type of StudyOriginal manuscript, Study of Diagnostic Test. Level of EvidenceII.

Comparison of post-operative complications, operative time and hospital stay between laparoscopic and open pyloromyotomy.

Objective: To compare operative time, hospital stay and post-operative complications between laparoscopic and open pyloromyotomy. Study Design: Randomized Prospective study. Setting: Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi. Period: 7th May 2022 to 7th November 2022. Material & Methods: This study included 20 patients each in the two groups. Group A underwent laparoscopic whereas group B underwent open pyloromyotomy. Both groups were compared regarding operative time (OT), hospital stay (HS) and post-operative complications. Results: OT ranged from 20 to 70 min with a mean of 15.4 min in group A. In group B, the mean OT was 25.6 min (range, 25–60 min). HS ranged from 14 to 58 hours with a mean of 16.8 hours in group A. In group B, it ranged from 19 to 30 hours, and the mean was 24.2 hours. One case in group A was converted to open approach (conversion rate 5%) because of mucosal perforation while one case of incomplete pyloromyotomy was found. Conclusion: Laparoscopic technique has shorter operative time and hospital stay than open surgery. Complication like mucosal perforation were seen in laparoscopy group, however, it was not found statistically significant.

A Systematic Review of the Long-Term Clinical Success of Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis.

Gastroparesis is a chronic and debilitating gastrointestinal disorder with few medical treatment options. Traditional surgical management has involved laparoscopic pyloromyotomy or gastric stimulation. In recent years, gastric peroral endoscopic myotomy (GPOEM) has become an attractive, less invasive option for patients with refractory gastroparesis. There is little information on the long-term clinical success of GPOEM in patients with refractory gastroparesis. This systematic review aims to evaluate the data on this procedure's long-term clinical efficacy and safety. A comprehensive literature review was done in PubMed, EMBASE, Ovid, and Google Scholar databases from the date of earliest entry in May 2017 up to August 15, 2022. The Gastroparesis Cardinal Symptom Index (GCSI) score, adverse reaction, and length of stay were analyzed. Eleven studies were eligible for inclusion (900 patients), seven of the studies were retrospective, while four were prospective. The GCSIis a 6-point Likert scale questionnaire that assesses improvement in gastroparesis. An average decrease of GCSI by 1 point compared to baseline GCSI for all patients (described as clinical success) was found in 662 patients out of 713 (92.8%) at one-year follow-up, 421 out of 460 (91.5%) at two-year follow-up, 270 out of 270 (100%) at three-year follow-up, and 102 out of 102 (100%) at four-year follow-up. Adverse events occurred in 62 out of 835 patients (in nine studies), with two of the most frequent being bleeding and mucosal tears. GPOEM is an effective and safe treatment option for patients with refractory gastroparesis, with symptom improvement noted up to four years postoperatively.

Single-incision versus conventional laparoscopic pyloromyotomy for pediatric hypertrophic pyloric stenosis: a systematic review and meta-analysis.

To assess the safety and efficacy of single-incision versus conventional laparoscopic pyloromyotomy in pediatrics, we conducted a systematic review and meta-analysis. A literature search was conducted to identify studies that compared single-incision laparoscopic pyloromyotomy (SILP) and conventional laparoscopic pyloromyotomy (CLP) for infants with hypertrophic pyloric stenosis (HPS). Meta-analysis was used to pool and compare variables such as operative time, time to full feeding, length of hospital stay, mucosal perforation, inadequate pyloromyotomy, wound infection, incisional hernia and overall complications. Among the 490 infants with HPS in the seven studies, 205 received SILP and 285 received CLP. There was significant longer time to full feeding for SILP compared with CLP. However, pooling the results for SILP and CLP revealed no significant difference in operative time, length of hospital stay and postoperative complications. SILP is a safe, feasible and effective surgical procedure for infants with HPS when compared to CLP. SILP is equivalent to CLP in terms of operative time, length of hospital stay and postoperative complications. We conclude that LS should be considered an acceptable option for HPS.

Nationwide trends of laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis in Germany: A slow path forward.

Since its introduction, laparoscopic pyloromyotomy (LP), has become increasingly popular in many countries. We have noticed an attenuated trend in Germany. The aim of this study was to analyse the distribution of open and LP in Germany. The national database of administrative claims data of the Institute for the Remuneration System in Hospitals (InEK) was analysed regarding numbers of patients with pyloromyotomy in the years 2019-2021. The German quality reports of the hospitals of 2019 and 2020 were analyzed regarding the number of procedures performed per hospital and pediatric surgical department. A total of 2050 patients underwent pyloromyotomy. The incidence of hypertrophic pylorus stenosis (HPS) was 699 and 657 patients in 2019 and 2021, respectively. Regarding age, 31.1% were admitted before 28 days of age. LP gradually increased from 216 patients (30.9%) in 2019 to 239 patients (36.4%) in 2021. Thirty-three laparoscopic operations (4.8%) were converted to an open approach. In 24 of all patients, there was an injury to the stomach, in 20 patients to the duodenum, needing repair with sutures. Analysis of the quality reports indicated that 44% of pediatric surgical departments performed LP. Although LP has became more prevalent in Germany recently, about two thirds of patients still undergo an open procedure.

Віддалені наслідки пілороміотомії в дітей

Hypertrophic pylorostenosis is one of the most frequent causes of vomiting in newborns requiring surgical intervention. While the intraoperative complications and immediate results of pyloromyotomy are widely reported in the literature, the remote consequences of this intervention, especially depending on the method of correction, are not well understood and contain contradictory results. Purpose - to study the remote consequences of pyloromyotomy depending on the method of surgical correction - open (OMPT) or laparoscopic pyloromyotomy (LMPT). Materials and methods. The primary assessment of long-term outcomes was performed by analysing the answers to the questions of the Diagnostic Questionnaire for Paediatric Functional Gastrointestinal Disorders, which was sent to 246 patients and their parents; responses were received from 169 (68.7%) respondents, who were included in the study. Re-hospitalisation was required in 57 (33.7%) children who underwent X-ray examination, fibrogastroscopy and ultrasonography. Statistical processing of the study results was performed using the software StatPlus: mac, AnalystSoft Inc. (version v8). Results. The average age of patients involved in the study was 8.5±0.3 years (range of fluctuations - from 2 to 18 years old). Among the respondents, 132 (78.1%) children underwent OPMT, and 37 (21.9%) children underwent LPMT. No complaints were expressed by 102 (60.4%) children, including 81 (61.4%) children after OPMT and 21 (56.8%) after LPMT (p=0.6152). The main complaint in children after pyloromyotomy, which required re-hospitalisation, was chronic abdominal pain, as indicated by 38 (22.5%) of the respondents. There was no correlation between the occurrence of chronic abdominal pain and the age at which hypertrophic pylorostenosis was diagnosed (R=0.183, p=0.2588), the duration of the disease (R=0.079, p=0.6275) and the child's body weight at the time of the intervention (R=0.048, p=0.768). Functional disorders of the digestive tract were diagnosed in 15 (8.9%) children. In 24 (14.2%) children, a slowdown in barium passage through the intestine was detected, which, in combination with periodic pain, indicated chronic adhesive disease. Fibrogastroscopy revealed duodenogastric reflux in 18 (10.7%) children, which in 5 (2.96%) patients was combined with pylorus insufficiency and in 12 (7.1%) with gastritis, and in 17 (10.1%) children gastroesophageal reflux was diagnosed. Conclusions. Thus, in the long term after pyloromyotomy, 33.7% of children required re-hospitalisation due to various pathologies of the gastrointestinal tract. Duodenogastric and gastroesophageal reflux and chronic adhesive disease were most often detected in the long term after pyloromyotomy, and the frequency of their occurrence did not depend on the method of surgical intervention. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Evaluation of the learning curve for laparoscopic pyloromyotomy.

Laparoscopic pyloromyotomy is the preferred surgical management of hypertrophic pyloric stenosis at most centers. We aimed to analyze the learning curve for laparoscopic pyloromyotomy using the experience of five fellowship-trained pediatric surgeons. A retrospective review of consecutive patients undergoing laparoscopic pyloromyotomy was performed. All cases were performed with general surgery residents. Cumulative sum (CUSUM) analysis for operating time was performed for up to the first 150 consecutive cases for individual surgeons. Outcomes were compared to identify different phases of the learning curve for operative competency. A total of 414 patients were included in the analysis as not all surgeons had reached 150 cases at time of analysis. The mean operating time was 29.2min for all cases across the 5 surgeons. CUSUM analysis for mean operating time revealed three phases of learning: Learning Phase (cases 1-16), Plateau Phase (cases 17-87), and a Proficiency Phase (cases 88-150). The mean operating time during the three phases was 34.1, 29.0, and 28.3min, respectively (P = 0.005). There were no differences in complications, reoperations, length of stay, or readmissions across the three phases. Three distinct phases of learning for laparoscopic pyloromyotomy were identified with no differences in outcomes across the phases. The operating time differed only for the Learning Phase, suggesting that some degree of proficiency occurs after 16 cases.

Natural history and consequence of patent processus vaginalis: An interim analysis from a multi-institutional prospective observational study

BackgroundThe prevalence and natural history of patent processus vaginalis (PPV) are unknown. An interim analysis was performed of a multi-institutional, prospective, observational study in neonates undergoing laparoscopic pyloromyotomy during which bilateral inguinal canals were evaluated. MethodsInfants under 4 months undergoing laparoscopic pyloromyotomy were enrolled at 8 children's hospitals. The presence of a PPV was evaluated and measurements recorded. Patients with a PPV are undergoing annual phone follow-up to 18 years of age. Interim analysis was performed. ResultsIn a cohort of 610 patient, 80 did not have a PPV examined, 4 had consent issues and were excluded, leaving 526 patients. Of these, 433 (82%) were male, median age 1.2 months (IQR 0.9, 1.6), median weight 3.89 kg (IQR 3.4, 4.46), and EGA 39 weeks (IQR 37, 40). There were 283 PPVs, 132 bilateral (47%), 116 right (41%), and 35 left (12%). Patients with a PPV were significantly younger (1.1 months (IQR 0.9, 1.5) vs 1.3 months (IQR 0.9, 1.7), p=0.02), weighed less (3.76kg (IQR 3.35, 4.26) vs 3.9kg (IQR 3.4, 4.5) p=0.03) and had a significantly lower EGA at birth (38 weeks (IQR 37, 40) vs 39 weeks (IQR 38, 40) p=0.003). Of 246 eligible infants, 208 (85%) responded to at least one annual follow-up. Two patients had an inguinal hernia repair for a symptomatic hernia, 49- and 51-days post pyloromyotomy. One had an orchiopexy and incidental inguinal hernia repair 120 days post pyloromyotomy; for a total of 3 (1.2%) hernia repairs. No additional hernias were identified in 116 patients with the PPV patients who have been followed for > 1 year. ConclusionsThe presence of a PPV at the time of pyloromyotomy is common but the need for hernia repair is rare within the first year of life. Continued long-term longitudinal follow-up of this cohort is needed. Level of EvidenceII

Fetal Disseminated Malignant Rhabdoid Tumor.

Fetal Disseminated Malignant Rhabdoid Tumor.

What information does YouTube offer on laparoscopic pyloromyotomy?

YouTube is overloaded with various medical videos and has become a common source for surgeons and the general public alike to update on surgical procedures. This study determined the quality and benefits of information with regards to laparoscopic pyloromyotomy on YouTube. A search was performed on YouTube using the key words "laparoscopic pyloromyotomy." All of the videos were viewed and evaluated by 2 surgeons watching the first 20 seconds and selected segments of each video to determine the content of the videos. The exclusion criteria were videos not related to laparoscopic pyloromyotomy, Microsoft-PowerPoint slide presentations and repeated videos. The search revealed 471 videos and video playlists, and of the 350 watched videos only 34 were on the topic of laparoscopic pyloromyotomy. Eight videos had an institutional source and 26 were private uploads. Among the analyzed videos, 11 were in high-definition (HD) and 23 non-HD. Regarding the country of origin, most of them were from India (N.=6) and the USA (N.=6), and regarding language, English was most common 28. The videos were uploaded between the years 2007-2016.The number of views ranged from 21 to 14,783 and mean duration of the videos was 2.55 min. There was a noticeable paucity of information as the largest number of videos offered a brief text description below only. Social media exposure of laparoscopic pyloromyotomy on YouTube can be summarized as follows: one-quarter of the videos are institutional uploads, English language videos top the list, mean video durations are 2.5 minutes with an average number of views >2500 and the majority of surgery videos focus on the main part of the procedure.

Effects of Opioid Sparing Analgesia for Surgical Procedure of Laparoscopic Pyloromyotomy in Order to Enhance Recovery and Better Surgical Outcomes

Aim: To determine the analgesic efficacy in early post operative period with out respiratory depression and to determine surgical outcome for patients under laparoscopic pyloromyotomy.
 Methodology: This study was done at Pediatric surgery operating theatre and Post anesthesia care unit (PACU). Peoples University of Medical and Health Sciences for women (PUMHSW) Nawabshah during the period of 2010-2022. Total 103 cases were observed with n=68 male and n=35 females. Ethical approval was obtained from PUMHSW ethical review board and written informed consent was taken from subjects’ parents or guardians. Infants of both sexes with 2-4.5 kg weight, age 3-8 weeks and diagnosed cases of infantile hypertrophic pyloric stenosis (IHPS) patients confirm by ultrasound were included in this study. Patients with the age of more than 2 months, with significant co morbid conditions, required an additional procedure during the operation, and those subjects possess a contraindication to the laparoscopic approach in the opinion of either the surgeon or the anesthesiologist were excluded from this study. Postoperative pain was measured by using the Neonatal Infant Pain Scale (NIPS) at 30,60,90,120 mins after completion of surgery.
 Results: In current study 103 patients were participated with male (n=68) to female (35) ratio 1.94:1 with mean age 34.94±7.31 days. Mean weight of the patients were studied 3.08±0.59 kg. Laparoscopic surgical procedure are less painful and patients can be managed by non opioid analgesic combination of intravenous acetaminophen with local anesthetic infiltration to achieved adequate pain relief and avoidance of delayed recovery, postoperative respiratory depression.
 Conclusion: Laparoscopic pyloromyotomy is safe and effective technique without postoperative respiratory depression and apneic episodes and better surgical outcome especially when opioid sparing multimodal analgesia is given.

Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis-A Systematic Review and Meta-Analysis.

Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the open versus laparoscopic technique. A literature search was conducted from 1990 to February 2021 using the electronic databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Primary outcomes were mucosal perforation and incomplete pyloromyotomy. Secondary outcomes consisted of length of hospital stay, time to full feeds, operating time, postoperative wound infection/abscess, incisional hernia, hematoma/seroma formation, and death. Seven randomized controlled trials including 720 patients (357 with OP and 363 with LP) were included. Mucosal perforation rate was not different between groups (relative risk [RR] LP versus OP 1.60 [0.49-5.26]). LP was associated with nonsignificant higher risk of incomplete pyloromyotomy (RR 7.37 [0.92-59.11]). There was no difference in neither postoperative wound infections after LP compared with OP (RR 0.59 [0.24-1.45]) nor in postoperative seroma/hematoma formation (RR 3.44 [0.39-30.43]) or occurrence of incisional hernias (RR 1.01 [0.11-9.53]). Length of hospital stay (-3.01h for LP [-8.39 to 2.37h]) and time to full feeds (-5.86h for LP [-15.95 to 4.24h]) were nonsignificantly shorter after LP. Operation time was almost identical between groups (+0.53min for LP [-3.53 to 4.59min]). On a meta-level, there is no precise effect estimate indicating that LP carries a higher risk for mucosal perforation or incomplete pyloromyotomies compared with the open equivalent. Because of very low certainty of evidence, we do not know about the effect of the laparoscopic approach on postoperative wound infections, postoperative hematoma or seroma formation, incisional hernia occurrence, length of postoperative stay, time to full feeds, or operating time.

Recurrent hypertrophic pyloric stenosis in an 8-week-old

Hypertrophic pyloric stenosis is a common cause of gastric outlet obstruction in the new born population. Pyloromyotomy is the treatment of choice following resuscitation, with relatively few complications. Recurrent pyloric stenosis is a rare complication with only eight cases reported in the literature. Although difficult to distinguish between an incomplete pyloromyotomy, there have been multiple cases presented in the literature of recurrent pyloric stenosis. Here we report a case of true recurrent hypertrophic pyloric stenosis treated successfully with a repeat laparoscopic pyloromyotomy.

Laparoscopic versus open pyloromyotomies: Outcomes and disparities in pyloric stenosis

PurposePyloromyotomy for hypertrophic pyloric stenosis (HPS) is one of the most common non-elective operations performed in the neonatal period. This project aims to explore outcomes of pyloromyotomy and compare differences between laparoscopic versus open pyloromyotomies in newborns diagnosed with HPS. MethodsThe Nationwide Readmissions Database (NRD) from 2010 to 2014 was queried to identify patients diagnosed with HPS that underwent repair. ResultsIn total, 30,915 children (18% female) underwent pyloromyotomy for HPS. Median length of stay for index admission was 2 days. A total of 212 (0.7%) patients required a redo pyloromyotomy. 127 (60%) were performed during index admission. Readmission rate at 30 days was 3% and 5% at one year, and 22% presented to a different hospital. The most common indications for readmission were feeding intolerance (24%), dehydration (10%), and malnutrition (10%). Patients from low-income households were more likely to present with malnutrition and weight loss (9% vs 4%, p<0.001) and had higher readmission rates (8% vs 4%, p<0.001). Laparoscopic pyloromyotomies accounted for 10% (n = 2951) of cases. Those undergoing laparoscopy were less likely to have electrolyte disturbances (41% vs 54%, p<0.001) or weight loss (2% vs 11%, p<0.001) on admission. The rate of open conversion was 1%. Intraoperative perforation was not more common in laparoscopic than open cases. Open pyloromyotomies had higher 30-day readmission rates and more surgical site infections. ConclusionComplications from pyloromyotomies are rare. Although infrequent, the incidence of incomplete pyloromyotomy is higher than previously reported and more common with open approaches. Newborns from low-income households are more likely to present with advanced symptoms and have disproportionately higher rates of readmission. Level of EvidenceLevel III Type of StudyTreatment Study, retrospective

Вибір методу лікування новонароджених із гіпертрофічним пілоростенозом

Hypertrophic pyloric stenosis (HPS) remains the main cause of projectile vomiting in newborns. During many decades the open pyloromyotomy was the main method of treatment in children with HPS due to the excellent results and low frequency of complications. After applying the laparoscopic pyloromyotomy, this approach gradually became accepted by pediatric surgeons. Regarding advantages and disadvantages of laparoscopic pyloromyotomy compared to conventional pyloromyotomy the literature data had a contradictory character. The aim is to analyze our own experience in the treatment of children with HPS using traditional and minimally invasive techniques. Materials and methods. This study based on the results of the treatment of 98 children, which were operated with pyloric stenosis during 2009–2020 years. Diagnosis was established on the results of clinical, laboratory investigation, and ultrasonographic data. Surgery was applied after correction of electrolytes disturbances, but a type of approach (open or laparoscopic) was chosen by surgeon. With the aim to evaluate the results the methods of variative statistic, parametric and nonparametric evaluation were applied. Results. Open pyloromyotomy was applied in 76 (77.6%) and laparoscopic – in 22 (22.4%) of children. Complications developed in 10 children, including 8 (10.5%) patients after open and 2 (9.1%) – after laparoscopic pyloromyotomy (p=0.842). Perforation of mucosa was in one (4.55%) child during laparoscopic pyloromyotomy, but in case of open approach this complication was absent. Independence of the approach, the cases of incomplete myotomy were absent. The surgical site infection (3.95%), postoperative hernia (2.63%), and adhesive bowel obstruction (2.63%) were more often observed after open pyloromyotomy. Laparoscopic pyloromyotomy characterized by the decrease of terms of starting enteral feeding (p&lt;0.001) and length of hospital stay (p=0.031) compared with open pyloromyotomy. Conclusions. Pyloromyotomy remains the main method of treatment of newborns with pyloric stenosis, but a type of approach was chosen by surgeon. Open and laparoscopic pyloromyotomy equally effective and safe for the treatment of children with the hypertrophic pyloric stenosis. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: hypertrophic pyloric stenosis, newborns, treatment, pyloromyotomy, laparoscopy.

For infants with pyloric stenosis, how does open pyloromyotomy compare with laparoscopic pyloromyotomy?

For infants with pyloric stenosis, how does open pyloromyotomy compare with laparoscopic pyloromyotomy?

Umbilical access in laparoscopic surgery in infants less than 3 months: A single institution retrospective review

IntroductionUmbilical access in laparoscopic surgery has been cited as a factor for increased complications in low-birth-weight infants and those less than three months old. In a previous series, 10.6% of pediatric surgeons reported complications in this population associated with umbilical access, citing carbon dioxide (CO2) embolism as the most common complication. To further examine the safety of this technique, we report our outcomes with blunt transumbilical laparoscopic access at our institution over four years. MethodsA retrospective review was performed of patients less than three months of age who underwent laparoscopic pyloromyotomy or inguinal hernia repair from 2016 to 2019. Operative reports, anesthesia records, and postoperative documentation were reviewed for complications related to umbilical access. Complications included bowel injury, vascular injury, umbilical vein cannulation, CO2 embolism, umbilical surgical site infection (SSI), umbilical hernia requiring repair, and death. ResultsOf 365 patients, 246 underwent laparoscopic pyloromyotomy, and 119 underwent laparoscopic inguinal hernia repairs. Median age at operation was 5.9 weeks [4.3,8.8], and median weight was 3.9 kg [3.4,4.6]. Nine complications (2.5%) occurred: 5 umbilical SSIs (1.4%), 1 bowel injury upon entry requiring laparoscopic repair (0.2%), 1 incisional hernia repair 22 days postoperatively (0.2%), and 2 cases of hypotension and bradycardia upon insufflation that resolved with desufflation (0.5%). There were no intraoperative mortalities or signs/symptoms of CO2 embolism. ConclusionIn this series, umbilical access for laparoscopic surgery in neonates less than three months of age was safe, with minimal complications. Although concern for umbilical vessel injury, cannulation, and CO2 embolism exists, these complications are not exclusively associated with umbilical access technique.

Return of the Banana Knife: An Alternative Instrument for Laparoscopic Pyloromyotomy.

Background: When the disposable arthroscopic banana knife (Linvatec, Largo, FL) became unavailable, many pediatric surgeons adapted the use of spatula tip cautery for laparoscopic pyloromyotomy; however, reusable arthroscopic knives remain readily available and are well suited to the procedure. Methods: We compared laparoscopic pyloromyotomy with a reusable arthroscopic banana knife (Sklar, West Chester, PA; catalog no. 45-6050) to those using spatula tip cautery at a single institution between September 1, 2012, and December 31, 2019. Mann-Whitney U test was used to compare operative time, room time, and time to discharge between groups. Results: Overall, 109 patients underwent pyloromyotomy for hypertrophic pyloric stenosis during the study time period. Of these, 12 were open and one was undertaken with the Storz pyloromyotomy knife, so these were excluded. A total of 74 (77.1%) laparoscopic cases with spatula tip cautery and 22 (22.9%) with the banana knife were included. Mean age at the time of surgery was ∼37 days. The majority of patients in each group were white, male, and full term. The most common comorbid conditions were reactive airway disease and neonatal abstinence syndrome. There were no significant differences in operative time (P = .61), room time (P = .41), or time from surgery to discharge (P = .26) between procedures using the banana knife and those using the cautery spatula tip. There were no perforations or recurrences. Conclusion: Our findings suggest that the reusable banana knife is a safe and effective alternative to spatula tip cautery for laparoscopic pyloromyotomy, with no difference in operative time, time from surgery to discharge, or complications.

Quality Assessment of YouTube Videos on Laparoscopic Pyloromyotomy Using a Validated Tool: An Appeal to Trainees to Follow the Peer-Reviewed Videos for Learning Purposes.

Background: Surgical trainees often resort to operative videos on the internet during preparation for surgery; YouTube is the most commonly explored video source by them. However, the quality of these videos is often questioned. This study was performed to assess the quality of available YouTube™ videos on laparoscopic pyloromyotomy (LP). Materials and Methods: The term "laparoscopic pyloromyotomy" was searched on YouTube on June 2, 2021, and 20 most-viewed videos on LP were included. A reference video on LP from WebSurg was also selected. The laparoscopic surgery video educational guidelines (LAP-VEGaS) tool was utilized for quality assessment of these videos. Descriptive variables, including the surgeon's details; year of video upload; duration of the video; view, like, and dislike counts; number of ports used; and instruments used for pyloromyotomy, were recorded and their relationship with video quality was studied. Results: The majority of videos were from the United States and India, and a surgeon could be identified in 90% of them. The median (range) video duration and view, like, and dislike counts were 2.89 (0.68-8.80) minutes, 2308 (1102-23,682), 5 (0-59), and 0 (0-11), respectively. The LAP-VEGaS score of the reference video was 17. In contrast, the scores of YouTube videos ranged from 1 to 14. The quality of these videos was poor in 5/9 domains. None of the descriptive variables showed a significant association with high video quality. Conclusion: Compared with the reference video, the overall quality of YouTube videos on LP was poor. Therefore, until a screening tool is available for selection of high-quality YouTube videos, trainees must resort to peer-reviewed video platforms.