THE LEARNING-CURVE FOR LAPAROSCOPIC PYLOROMYOTOMY

Over a 34-month period, 51 open and 33 laparoscopic pyloromyotomies we re performed for infantile hypertrophic pyloric stenosis. The patients ' weight ranged from 1.2 to 5.3 kg. The mean operating time was 28 min utes for the open group and 41 minutes for the laparoscopic group, The average time to accept normal feeds was 41 hours in the open group en d 32 hours in the laparoscopic group. There were three perforations, o ne inadequate pyloromyotomy, and one wound infection in the open group . In the laparoscopic group one patient underwent conversion to open s urgery because of a duodenal perforation and three other patients requ ired subsequent open procedures for duodenal perforation (n = 1), pylo ric perforation (n = 1) and inadequate pyloromyotomy (n = 1), Addition al complications in the laparoscopic group included two cases of oment al extrusion through the umbilical port wound and one suture abscess. On the basis of these results we have modified our technique, and ther e have been no complications after laparoscopic pyloromyotomy in our l ast 10 patients. We believe laparoscopic pyloromyotomy requires furthe r evaluation before it is accepted into common practice. Copyright (C) 1997 by W.B. Saunders Company.