Is the Hook Efficient for Laparoscopic Pyloromyotomy?

Aim: to evaluate the efficacy of the hook in performing laparoscopic pyloromyotomy.

Study Design: prospective study.

Place and Duration of the Study: pediatric surgery unit at general surgery department at Tanta university hospitals, between June 2019 and July 2020.

Patients and Methods: This study was carried out on 15 infants (12 males and 3 females) suffering from infantile hypertrophic pyloric stenosis (IHPS). Patients were evaluated according to their age, weight, onset and duration of projectile non bilious vomiting and abdominal ultrasound was done measuring the pyloric muscle thickness and length. Patients were evaluated for dehydration then operated after resuscitation. Three ports/stab incisions were used: one for the telescope at the umbilicus (5 mm), then two working ports/stab incisions at the right anterior axillary line at the level of the umbilicus and at the left of the midline above the level of the umbilicus (3 mm). After fixation of the pyloric mass, pyloromyotomy was performed using the hook. Operative time was calculated. Intraoperative difficulties in using the hook were assessed. Postoperative feeding, pain and cosmesis were assessed.

Results: The mean age at time of presentation was 34.4 days. The mean operative time was 44.5 min. Mucosal perforation occurred at one case. Mean time to full oral feeding was 9.8 h except the perforated case. Postoperative pain using NIPS was mild in 26.67%, moderate in 66.67% and severe in 6.67%. Postoperative hospital stay was 1 day in all cases except the perforated case.

Conclusion: Laparoscopic pyloromyotomy can be done using the hook and has a good outcome and excellent cosmesis. Hook is used for making the incision of pyloromyotomy by using the high cutting mode in continuous incision without hesitancy. Adequate depth of the incision -by the back of cold hook- is essential for easy spreading.