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  • Features of surgical treatment of congenital hypertrophic pyloric stenosis using the laparoscopic technique 
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Features of surgical treatment of congenital hypertrophic pyloric stenosis using the laparoscopic technique 

Features of surgical treatment of congenital hypertrophic pyloric stenosis using the laparoscopic technique 
 

Spakhi O.V.

Zaporizhzhia State Medical University, Ukraine


The objective: to study the features of laparoscopic pyloromyotomy and possibilities of endoscopic treatment for congenital hypertrophic pyloric stenosis (CHPS).


Material and methods. There were analyzed 73 children with CHPS. In 43 cases, laparoscopic pyloromyotomy (I group) was performed. Standard Fredеt-Weber-Ramstedt surgery was made in 30 specially selected patients from the control group (group II), which was statistically homogeneous with the study group in terms of gender, age, disease duration and extent of homeostasis disorders.


Results and discussion. Diagnosis of CHPS in all children was established on the basis of clinical manifestations of disease, palpation of the thickened pylorus (32%), ultrasound of the stomach (39%), fibrogastroscopy (12%) and radiographic examination (17%). Underweight in the examinees corresponded to the II degree of malnutrition (p<0.05), and the mean dise ase duration was 11.9±0.6 (p<0.05) days. Preoperative preparation for endoscopic intervention did not require the use of any additional methods and did not differ from the preparation of patients for open surgery, which is consistent with results from other cli nics. It was found that laparoscopic procedure is well tolerated by children, and its duration significantly (p<0.05) lower than that of open pyloromyotomy. In the early postoperative period, date of feeding start and recovery of its age volumes decreased by on average 2 times. Average length of children’s stay in the hospital decreased significantly too.


Conclusions. The use of laparoscopic technique in the surgical treatment of congenital pyloric stenosis enables not only to adequately restore the patency of pylorus, but also provides good cosmetic effect, facilitates the early postoperative period. With enough experience of the surgeon and anesthetist, laparoscopic procedures can be carried out successfully and well tolerated by infants.


Key words: congenital hypertrophic pyloric stenosis, children, laparoscopic pyloromyotomy.


References

1. Solovev AE, Kireev SS, Spahi OV, Lyaturinskaya OV, Zaporozhchenko AG. 2005. Laparoskopicheskaya piloromiotomiya pri vrozhdennom gipertroficheskom pilorostenoze. Zaporozhskiy meditsinskiy zhurnal. 1: 64-66.

2. Spakhy OV. 2008. Diahnostyka ta khirurhichne likuvannia vrodzhenoi neprokhidnosti shlunku u ditei. Avtoref dys… d-ra med nauk. 14.01.09. Natsionalnyi med univer im OO Bohomoltsia. K: 32.

3. Acker SN, Garcia AJ, Ross JT, Somme S. 2015, Apr. Current trends in the diagnosis and treatment of pyloric stenosis. Pediatr Surg Int. 31(4): 363-366.

4. Alain JL, Grosseau D, Terrier G. 1991. Extramucosal pyloromyotomy by laparoscopy. J Pediatr Surg. 26: 1191-1192.

5. Downey EC. 1998. Laparoscopic pyloromyotomy. Semin Pediatr Surg. 7: 220-224.

6. Iwanaka T. 2014, Nov. Past, present, and future of pediatric endoscopic surgery. Nihon Geka Gakkai Zasshi. 115(6): 329-33.

7. Ford WDA, Crameri JA, Holland AJA. 1997. The learning curve for laparoscopic pyloromyotomy. J Pediatr Surg. 32: 552-554.

8. Hamada Y, Tsui M, Kogata M, Hioki K, Matsuda T. 1995. Surgical technique of laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis. Surg Today. 25: 754-756.

9. Handu AT, Jadhav V, Deepak J, Aihole JS, Gowrishankar, Narendrababu M, Ramesh S, Srimurthy K. 2014. Laparoscopic pyloromyotomy: Lessons learnt in our first 101 cases. J Indian Assoc Pediatr Surg. 19(4): 213-217.

10. Lawrence J. 2015, Mar. Regarding risk of incomplete pyloromyotomy and mucosal perforation in open andlaparoscopic pyloromyotomy. Pediatr Surg. 50(3): 497

11. Tan HL, Najmaldin A. 1993. Laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis. Pediatr Surg Int. 8: 376-378.

12. Tytgat SH, Stolwijk LJ, Keunen K, Milstein DM, Lemmers PM, van der Zee DC. 2015, Apr. Brain oxygenation during laparoscopic correction of hypertrophic pyloric stenosis. J Laparoendosc Adv Surg Tech A. 25(4): 352-357.

13. Vahdad MR, Nissen M, Semaan A, Klein T, Pala de E, Boemers T, Troebs RB, Cernaianu G. 2014. Can a simplified algorithm prevent incomplete laparoscopic pyloromyotomy? J Pediatr Surg. 11: 723-727