Complication Avoidance in Miniature Access Pyloromyotomy

Abstract

Miniature access pyloromyotomy is a well-established procedure for the management of infants with pyloric stenosis. Several studies comparing the miniature access and open approaches have found that the incidence of complications is similar in both. It appears that the miniature access approach offers potential benefits such as superior cosmetic results, earlier feeding, and a shorter hospital stay. We describe our complications and complication avoidance techniques for this procedure. A 2-year period was selected for the study, and 160 infants undergoing miniature access pyloromyotomy at two centers were analyzed. Complications occurred in 7 (4.38%) of the 160 cases: 2 duodenal perforations (1.25%), 2 incomplete myotomies (1.25%), 1 omental evisceration (0.62%), and 2 umbilical wound infections (1.25%). The following measures were taken to prevent complications: avoiding the umbilicus if epithelialization was inadequate, using low flow and moderate pressure carbon dioxide insufflation, careful grasp of the duodenum, using a retractable knife, making the ideal myotomy incision, using a special pyloric spreader, applying slow gentle pressure during spreading, and meticulously inspecting the mucosal surface and duodenum after the myotomy. Miniature access pyloromyotomy is an excellent procedure with specific and potentially avoidable complications. Key complication avoidance techniques should be used.