Does Number of Ports Affect Outcomes in Patients Undergoing Laparoscopic Pyloromyotomy? Retrospective Chart-Review Study

Background. Although open Ramstedt's pyloromyotomy is the gold standard for the surgical management of infantile hypertrophic pyloric stenosis, laparoscopic pyloromyotomy has been found highly successful. Various factors, however, can affect the outcomes of surgical interventions in these patients. We observed a relationship between the number of ports used and outcome in patients undergoing laparoscopic pyloromyotomies. Methods. We retrospectively assessed the medical records of selected group of patients who underwent laparoscopic pyloromyotomy in our institution. Factors analyzed included operation time, length of hospital stay, postoperative complications, and time to postoperative full feeding. Results. We observed failure of myotomy in both two patients who underwent laparoscopic pyloromyotomy using only two working ports compared to successful myotomies in the remaining patients. Conclusion. Laparoscopy provides good results in terms of intraoperative exposure and cosmesis. However, standardized surgical technique with two working ports is advisable, and this can trigger further research to be ascertained. 1. Introduction Infantile hypertrophic pyloric stenosis (IHPS) is a common condition affecting young infants; despite its frequency, IHPS has been recognized as a condition for only a little over a century and its etiology remains unknown [1]. Among the approaches used for pyloromyotomy are umbilical skin-fold incision [2] and laparoscopy [3]. Several factors can affect the outcomes of surgical intervention in these patients. In this case series, we observed a relationship between the number of ports and the outcome in patients undergoing laparoscopic pyloromyotomy. 2. Methods We assessed patients who had undergone laparoscopic pyloromyotomy at our institution. IHPS was diagnosed by pyloric muscle thickness >4？mm and length >14？mm on ultrasonography. The study protocol was approved by our institution’s Internal Review Board. There was no external source of funding. Patients were excluded if they had been born prematurely (before 37 weeks of gestation) or had recent respiratory infections, major developmental anomalies, or had undergone prior abdominal surgery. All the procedures were performed by one surgeon. The case notes of these patients were retrospectively reviewed for age of the patients at operation, subsequent surgical interventions, and patient outcomes. The primary end points of this study were rate of postoperative vomiting and ultimately the need for revision pyloromyotomy. Secondary outcome measures included operation time, length