Author(s): International Pediatric Endosu
Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infants and presents as one of the most common surgical conditions of infancy(1). It occurs in 1 to 3 of every 1000 live births(2). The problem is associated with a 4:1 male-to-female ratio. Pyloric stenosis appears to be more common in infants of Caucasian decent and is rare in Asian children(3). It is an acquired disorder of unknown etiology in which hypertrophy of the muscle fibers of the pylorus occurs, causing a mechanical obstruction of the gastric outlet along with its associated metabolic and electrolyte abnormalities. This condition has been successfully treated for decades with the open Ramstedt extramucosal pyloromyotomy, which clearly stands as the gold-standard treatment against which all other techniques must be compared(4) . So highly effective is this simple, elegant, and inexpensive operation that it has been described as ‘one of the most easy and gratifying procedures performed by pediatric surgeons”(5) and ‘the most consistently successful operation ever described”(6). Despite the success and popularity of the Ramstedt pyloromyotomy, complications occasionally do occur including prolonged post-operative emesis, wound infection, and duodenal perforation. In addition, there is a permanent scar, which may negatively impact on the self image of some children. To deal with the issue of cosmesis some surgeons have advocated a circumumbilical incision for pyloromyotomy(7). However, it appears that this approach, although an acceptable alternative to Ramstedt’s technique, has its own shortcomings including infection, incisional hernia, and prolonged gastroparesis. The laparoscopic approach to pyloromyotomy obviates many of these concerns. There is clearly an advantage as far as cosmesis is concerned and the anticipated increased complication rate and costs have not consistently been demonstrated. The technique has evolved over the last decade and appears to be at the very least an acceptable alternative to the time-honored open approach.