Ergonomic laparoscopic spreader for infantile hypertrophic pyloric stenosis

摘要

Background: Laparoscopic pyloromyotomy (LP) for Infantile Hypertrophic Pyloric Stenosis (IHPS) is associated with an increased risk of mucosal tears or incomplete myotomy when compared with open myotomy. Keeping these risks in mind, a new ergonomically designed spreader for LP was developed and investigated in IHPS. Methods: The new Pyloric Spreader was designed as a 3.5 mm instrument specifically for minimal access application taking into consideration the specific needs of LP. Results: LP was performed using this spreader in 25 infants with IHPS during a 5-year period from 2006-2012. After incising the pylorus using an arthrotomy knife blade, the spreader could be inserted with ease in the pyloric muscle slit and permitted spreading of the pyloric muscle without any circular tears. The axial handle attached to the spreader enable a wide and controlled muscular spreading without mucosal injuries or incomplete spreads. Two infants underwent surgical revision due to recurrent vomiting; however no signs of incomplete myotomy were evident and the vomiting which subsequently subsided was attributed to the preoperative administration of Rotavirus vaccines in these infants. Conclusion: The newly designed Pyloric Spreader offers a new ergonomically designed instrument with a flat tip for easy placement in the pyloric muscle slit, broad instrument surface to avoid circular muscle tears, rounded tip edges to prevent mucosal injuries, wide spreading capability for optimal muscle spread and an axial handle for better hand ergonomic for LP in IHPS.