LETTER TO THE EDITOR
|Year : 2017 | Volume
| Issue : 1 | Page : 62
Ankur Paed Surgical Clinic, 1666, E 10th Lane Rajarampuri Kolhapur, Maharashtra, India
|Date of Web Publication||23-Nov-2016|
Ankur Paed Surgical Clinic, 1666, E 10th Lane Rajarampuri Kolhapur, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kittur D. Laparoscopic pyloromyotomy. J Indian Assoc Pediatr Surg 2017;22:62
The recent article Laparoscopic Pyloromyotomy: "Lessons learnt in our first 101 cases" which appeared in Journal of Indian Association of Pediatric Surgeons October-December 2014/Vol 19/Issue 4 was thought provoking. The authors have very truthfully reported a high incidence of inadequate pyloromyotomy and the need for a re-do. However, this is unacceptable.
Pediatricians have reached the corners of the country and with increased awareness the diagnosis of infantile pyloric stenosis is done early. Gone are the days when we would often see a baby in severe dehydration and electrolyte imbalance. With the growing pressures about the short hospital stay, etc., there is undue haste in taking up the infant for surgery. In laparoscopic pyloromyotomy, one does not feel t&he tumor as in open surgery. Complications could have been reduced by giving the hard pylorus rest for at least 24 h and ice cold saline washes for the stomach.  This softens the tumor and reduces the mucosal edema. Inadequate pylormyotomy is usually at the duodenal end because the surgeon is afraid of opening the thin duodenal mucosa. Furthermore, the postoperative feeding can be delayed to prevent emesis and resulting anxiety of the parents and surgeons alike.
The authors have laid a lot of stress on reducing the operating time. Probably this matters too much in the metro cities and corporate hospitals. Authors report that two patients were re-operated on the 4 th and 5 th day after surgery. The pylorus tends to get kinked and gets adherent to the under surface of the liver.  After giving due rest, the obstruction should have been proved by a contrast study before taking up the patients for a re-do surgery.
A bad cosmetic result cannot be used as a criterion to downgrade open pyloromyotomy, which is a gold standard even today. A bad scar is a result of a hurried and improper closure of the abdominal wound.
It was interesting to know that during counseling of parents for the need of surgery, they were not allowed to choose between open and laparoscopic pyloromyotomy. Also what was the number of open pyloromyotomies done by the authors and residents in the same period and their complications. This article will help the upcoming pediatric surgeons to decide whether they would learn and do laparoscopic pyloromyotomy.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Kittur DH. Re-exploration in cases of infantile pyloric stenosis - Report of 2 cases. J Indian Assoc Pediatr Surg 1996;1:125-6.
Kittur DH, Bhagwat S. Re-do surgery in children. 1 st
ed. Kolhapur: Dr. Kittur; 1999. p. 68-9.Use of WhatsApp in Pediatric Surgery Division of General Surgery Department: Is it Worthwhile?