Laparoscopic pyloromyotomy

Laparoscopic Pyloromyotomy

Laparoscopic pyloromyotomy is a minimal access technique for the treatment of hypertrophic pyloric stenosis (HPS). The muscle at the stomach outlet is thickened, and this keeps food from moving into the small bowel. This condition commonly affects infants.

Laparoscopic Pyloromyotomy Benefits

• Little scarring and smaller incisions.
• Shortened time of recovery in comparison with open surgery.
• Less postoperative pain
• Reduction in Length of stay (which is often in 24-48 hours in the hospital)
• The chances of wound infection is minimal

Laparoscopic pyloromyotomy surgery

The procedure involves cutting this muscle to remove the obstruction and restore normal digestion.

Step-by-Step Surgical Procedure:

Before Surgery

• The child is assessed and put into a stable state prior to surgery (providing a fix of dehydration and electrolyte imbalance, namely, low chloride and potassium).
• Several hours before surgery, the baby is put nil per oral (NPO).
• General anaesthesia is done.
• To remove the contents of the stomach a nasogastric tube can be inserted.

Positioning and Sterile Set up

• The infant lies in the operating table in a supine position (lying back on the back).
• Abdomen is cleansed and covered in a sterile way.
• Positioning: The surgeon will be behind the feet of the patient, and the monitor will be in a visual position.

Creation of Small Incisions

Three small cuts (3-5 mm) are to be done:

• One close to the umbilicus (to the camera/ laparoscope).
• Two upper abdomen (surgery instruments)

Insertion of Laparoscopic Instruments

• The umbilical port introduces a laparoscope (thin camera).
• Carbon dioxide gas (CO2) is introduced into the abdomen to provide working space.
• Two laparoscopic graspers or dissectors are to be inserted using the side ports that are fine.

Detection of the Pylorus

• The surgeon identifies the hypertrophied pylorus (in the form of a hard, large, and olive-like swelling).
• It is held and rotated so as to be exposed in the best way.

Performing the Myotomy

• It is incised longitudinally through the seromuscular of pylorus between the antrum and the duodenal end.
• The thick muscle fibers are then carefully parted with blunt dissection until the underlying mucosa is protruded- out- of shape- this is an indication that the muscle is entirely divided.
• The mucosa is not torn, the outer layer of the muscle is torn.

Examining the Mucosa Integrity

• The surgeon tries to make sure that they do not perforate the mucosa (infrequent complication).
• Air or saline can be sometimes injected via the nasogastric tube to ensure that there is no leakage.

Completion and Closure

• After the pyloromyotomy is done and adequate has been confirmed, the instruments are taken out.
• The gas is CO 2 which is emitted through the abdomen.
• Absorbable sutures or surgical glue are used to close small incisions.
• Sterile dressings are used.

Postoperative Care

• The infant will be moved in the recovery room to observe it.
• Nourishment often commences 48-8 hours after surgery and begins with low level of fluid or milk of clear nature.
• Mild vomiting comes initially and usually resolves in 24-48 hours.
• The discharge normally takes 1-2 days.

Surgery Duration

• The whole procedure usually takes about 30 to 45 minutes. 

Pediatric laparoscopic pyloromyotomy

Pediatric laparoscopic pyloromyotomy operation is low-impact surgery that treats infant hypertrophic pyloric stenosis (HPS) - the muscles leading from your baby’s stomach to the small bowel thicken and ultimately, prevents nourishment from proceeding. It is intended to relieve the obstruction from this hypertrophy and allow normal feeding, by dividing the overgrown pyloric muscle while sparing damage to the inner lining (mucosa) of the pylorus.

Indication

Infantile hypertrophic pyloric stenosis is the primary sign in pediatric pyloromyotomy, and is observed in:

• Infants aged 2 to 8 weeks
• Males more so than females.

Symptoms include:

Projectile vomiting, painful.

• Dehydration
• Failure to gain weight
• Gastric peristalsis is visible following feeding.

Laparoscopic pyloromyotomy success rate

Laparoscopic pyloromyotomy is a successful and is more or less universally accepted as a procedure in the treatment of hypertrophic pyloric stenosis (HPS), particularly in infants. In the last twenty years, it has emerged as the best alternative to open surgery because of its high success rate, low level of invasiveness and rapid healing.

Overall Success Rate

• Laparoscopic pyloromyotomy works well—success rates usually land between 95 and 99 percent.
• This implies that almost all babies feel relief of the obstruction, and they go on with normal feeding shortly after an operation.

Best hospital for laparoscopic pyloromyotomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Laparoscopic pyloromyotomy is a safe, efficient, and minimally invasive surgical intervention to treatment of hypertrophic pyloric stenosis in infants. It allows symptoms like projectile vomiting and intolerance to food to be removed by a precise division of the thickened pyloric muscle, which consequently allows gastric emptying to take place normally. Laparoscopic pyloromyotomy has been regarded as a better procedure as it has a success rate of 95-99, less scarring, and quicker recovery and less postoperative pain that is experienced compared to open surgery and has become the procedure of choice of all pediatric surgeons globally. The majority of the infants resume feeding in several hours and regain normal wellbeing in several days which results to the good outcomes in the long run and normal growth and development.

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FAQ

1. What age do you normally perform this surgery?

• It is usually done in infants between the ages of 2 and 8 weeks where hypertrophic pyloric stenosis normally occurs.

2. Will my baby have any scars on it?

• Only small cuts (3-5 mm) are done so that the scars are minimal or almost non-existent.

3. Is pyloric stenosis recurrent following surgery?

• Recurrence is extremely rare.

4. What about after the surgery? 

• Kids bounce back and grow just like any other child. No lasting digestive problems, nothing to worry about down the line.