The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Antonino Appignani - One of the best experts on this subject based on the ideXlab platform.
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preliminary experience with a new approach for infantile hypertrophic pyloric stenosis the single port laparoscopic assisted Pyloromyotomy
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Mirko Bertozzi, Marco Prestipino, N Nardi, Antonino AppignaniAbstract:Ramstedt Pyloromyotomy is still the procedure of choice for infantile hypertrophic pyloric stenosis; however, the best way to approach the pylorus is debated. Recent literature reports many comparisons between various open approaches and laparoscopic one. The purpose of this preliminary experience is to show a new approach to infantile hypertrophic pyloric stenosis: single-port, laparoscopic-assisted Pyloromyotomy. Nineteen infants underwent single-port laparoscopic-assisted Pyloromyotomy. The approach to the abdominal cavity is performed through a right circumbilical incision, and then a 12-mm trocar is inserted. After the pneumoperitoneum is established, an operative telescope is introduced. Once the telescope is inserted, the pylorus is easily located, and then grasped and exteriorized via the umbilical incision. At this point, conventional Ramstedt Pyloromyotomy is performed. Once the pylorus is reintroduced in the abdomen, a new pneumoperitoneum is created to control mucosal integrity and hemostasis. A retrospective statistical analysis was performed to compare patients who underwent this technique to others approached by the same team with right upper quadrant incision or right semicircular umbilical skin-fold incision. In all 19 cases, adequate Pyloromyotomy was performed in a good ranging time without any intra- or post-operative complications, achieving excellent early cosmetic results. The feasibility of single-port, laparoscopic-assisted Pyloromyotomy obtained in this small sample suggests that this procedure could be an excellent alternative to open or laparoscopic Pyloromyotomy as long as it acts as intermediary between the two techniques.
Henry P. Parkman - One of the best experts on this subject based on the ideXlab platform.
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endoflip and pyloric dilation for gastroparesis symptoms refractory to Pyloromyotomy pyloroplasty
Digestive Diseases and Sciences, 2021Co-Authors: Asad Jehangir, Zubair Malik, Roman V. Petrov, Henry P. ParkmanAbstract:Gastroparesis patients may undergo Pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation may improve their symptoms. We aimed to (1) assess if pyloric through-the-scope (TTS) balloon dilation results in symptom improvement in gastroparesis patients with suboptimal response to Pyloromyotomy/pyloroplasty and (2) determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation. Patients with severe gastroparesis refractory to Pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation after assessing the pyloric characteristics using EndoFLIP. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups. Thirteen (ten females) patients (mean age 45.2 ± 5.1 years) with severe gastroparesis symptoms (mean GCSI total score 3.4 ± 0.3) after Pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. Overall, there was improvement in symptoms at 1-month follow-up (mean GCSI total score 3.0 ± 0.4, mean CPGAS score 1.6 ± 0.5, p < 0.05 for both), with five (38%) patients reporting symptoms somewhat/moderately better. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml, 40 ml, and 50 ml than patients with little/no improvement (all p < 0.05). In gastroparesis patients with refractory symptoms after Pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric distensibility on EndoFLIP suggesting incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with gastroparesis symptoms refractory to Pyloromyotomy/pyloroplasty.
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endoflip and pyloric dilation for gastroparesis symptoms refractory to Pyloromyotomy pyloroplasty
Digestive Diseases and Sciences, 2020Co-Authors: Asad Jehangir, Zubair Malik, Roman V. Petrov, Henry P. ParkmanAbstract:BACKGROUND Gastroparesis patients may undergo Pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation may improve their symptoms. AIMS We aimed to (1) assess if pyloric through-the-scope (TTS) balloon dilation results in symptom improvement in gastroparesis patients with suboptimal response to Pyloromyotomy/pyloroplasty and (2) determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation. METHODS Patients with severe gastroparesis refractory to Pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation after assessing the pyloric characteristics using EndoFLIP. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups. RESULTS Thirteen (ten females) patients (mean age 45.2 ± 5.1 years) with severe gastroparesis symptoms (mean GCSI total score 3.4 ± 0.3) after Pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. Overall, there was improvement in symptoms at 1-month follow-up (mean GCSI total score 3.0 ± 0.4, mean CPGAS score 1.6 ± 0.5, p < 0.05 for both), with five (38%) patients reporting symptoms somewhat/moderately better. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml, 40 ml, and 50 ml than patients with little/no improvement (all p < 0.05). CONCLUSIONS In gastroparesis patients with refractory symptoms after Pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric distensibility on EndoFLIP suggesting incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with gastroparesis symptoms refractory to Pyloromyotomy/pyloroplasty.
John H T Waldhausen - One of the best experts on this subject based on the ideXlab platform.
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Pyloromyotomy a comparison of laparoscopic circumumbilical and right upper quadrant operative techniques
Journal of The American College of Surgeons, 2005Co-Authors: Stephen S Kim, Stanley T Lau, Steven L Lee, Robert T Schaller, Patrick J Healey, Daniel J Ledbetter, Robert S Sawin, John H T WaldhausenAbstract:Background Ramstedt Pyloromyotomy through a right upper quadrant (RUQ) transverse incision has been the traditional treatment for hypertrophic pyloric stenosis. Recently, laparoscopic (LAP) and circumumbilical (UMB) approaches have been introduced as alternative methods to improve cosmesis, but concerns about greater operative times, costs, and complications remain. This study compares the three operative techniques and examines their advantages and complication rates. Study design We performed a retrospective review of patients undergoing Pyloromyotomy at a children's hospital between January 1997 and June 2003. Results Two hundred ninety patients underwent Pyloromyotomy by LAP (n = 51), RUQ (n = 190), or UMB (n = 49). Complication rate, time to ad libitum feeding, incidence of emesis, and postoperative length of stay did not differ considerably among groups. Two LAP patients were converted to RUQ. Mucosal perforation occurred in three patients each in the RUQ and UMB groups, but none in the LAP group. Operative times were considerably less for LAP (25 ± 9 minutes) than for RUQ (32 ± 9 minutes) and UMB (42 ± 12 minutes) (p Conclusions Advantages of LAP include a shorter mean operative time without higher complications or costs. UMB is associated with the greatest mean operative time and costs. Laparoscopic Pyloromyotomy is a safe and effective approach to the treatment of hypertrophic pyloric stenosis.
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Pyloromyotomy a comparison of laparoscopic circumumbilical and right upper quadrant operative techniques
Journal of The American College of Surgeons, 2005Co-Authors: Robert T Schaller, Patrick J Healey, Daniel J Ledbetter, Robert S Sawin, John H T WaldhausenAbstract:BACKGROUND: Ramstedt Pyloromyotomy through a right upper quadrant (RUQ) transverse incision has been the traditional treatment for hypertrophic pyloric stenosis. Recently, laparoscopic (LAP) and circumumbilical (UMB) approaches have been introduced as alternative methods to improve cosmesis, but concerns about greater operative times, costs, and complications remain. This study compares the three operative techniques and examines their advantages and complication rates. STUDY DESIGN: We performed a retrospective review of patients undergoing Pyloromyotomy at a children's hospital between January 1997 and June 2003. RESULTS: Two hundred ninety patients underwent Pyloromyotomy by LAP (n = 51), RUQ (n = 190), or UMB (n = 49). Complication rate, time to ad libitum feeding, incidence of emesis, and postoperative length of stay did not differ considerably among groups. Two LAP patients were converted to RUQ. Mucosal perforation occurred in three patients each in the RUQ and UMB groups, but none in the LAP group. Operative times were considerably less for LAP (25 +/- 9 minutes) than for RUQ (32 +/- 9 minutes) and UMB (42 +/- 12 minutes) (p < 0.05, ANOVA, Bonferroni). Charges related to operations and anesthesia were considerably greater for UMB (operation: US 1,574 dollars +/- US 433 dollars; anesthesia: US 731 dollars +/- US 190 dollars) compared with the other two groups (p < 0.05, ANOVA, Bonferroni), but did not differ between LAP (operation: US 1,299 dollars +/- US 311 dollars; anesthesia: US 586 dollars +/- US 137 dollars) and RUQ (operation: US 1,237 dollars +/- US 411 dollars; anesthesia: US 578 dollars +/- US 167 dollars). Data are presented as mean +/- SD. CONCLUSIONS: Advantages of LAP include a shorter mean operative time without higher complications or costs. UMB is associated with the greatest mean operative time and costs. Laparoscopic Pyloromyotomy is a safe and effective approach to the treatment of hypertrophic pyloric stenosis.
Daniel J. Ostlie - One of the best experts on this subject based on the ideXlab platform.
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parental and volunteer perception of Pyloromyotomy scars comparing laparoscopic open and nonsurgical volunteers
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2016Co-Authors: Shawn D. St. Peter, Susan W. Sharp, Charles W Acher, Sohail R Shah, Daniel J. OstlieAbstract:Abstract Introduction: Despite evidence from prospective trials and meta-analyses supporting laparoscopic Pyloromyotomy (LP) over open Pyloromyotomy (OP), the open technique is still utilized by some surgeons on the premise that there is minimal clinical benefit to LP over OP. Although the potential cosmetic benefit of LP over OP is often cited in reports, it has never been objectively evaluated. Methods: After internal review board approval, the parents of patients from a previous prospective trial who had undergone LP (n = 9) and OP (n = 10) were contacted. After consent was obtained, the parents and patients were asked to complete a validated scar scoring questionnaire that was compared between groups. Standardized photos were taken of study subjects and controls with no abdominal procedures. Blinded volunteers were recruited to view the photos, identify if scars were present, and complete questions if a scar(s) was seen. Volunteers were also asked about the degree of satisfaction if their child had si...
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risk of incomplete Pyloromyotomy and mucosal perforation in open and laparoscopic Pyloromyotomy
Journal of Pediatric Surgery, 2014Co-Authors: Nigel J Hall, Daniel J. Ostlie, Shawn D. St. Peter, Simon Eaton, Aaron Seims, Charles M Leys, John C Densmore, Casey M Calkins, Richard G Azizkhan, Daniel Von AllmenAbstract:Abstract Background Despite randomized controlled trials and meta-analyses, it remains unclear whether laparoscopic Pyloromyotomy (LP) carries a higher risk of incomplete Pyloromyotomy and mucosal perforation compared with open Pyloromyotomy (OP). Methods Multicenter study of all pyloromyotomies (May 2007–December 2010) at nine high-volume institutions. The effect of laparoscopy on the procedure-related complications of incomplete Pyloromyotomy and mucosal perforation was determined using binomial logistic regression adjusting for differences among centers. Results Data relating to 2830 pyloromyotomies (1802 [64%] LP) were analyzed. There were 24 cases of incomplete Pyloromyotomy; 3 in the open group (0.29%) and 21 in the laparoscopic group (1.16%). There were 18 cases of mucosal perforation; 3 in the open group (0.29%) and 15 in the laparoscopic group (0.83%). The regression model demonstrated that LP was a marginally significant predictor of incomplete Pyloromyotomy (adjusted difference 0.87% [95% CI 0.006–4.083]; P =0.046) but not of mucosal perforation (adjusted difference 0.56% [95% CI −0.096 to 3.365]; P =0.153). Trainees performed a similar proportion of each procedure (laparoscopic 82.6% vs. open 80.3%; P =0.2) and grade of primary operator did not affect the rate of either complication. Conclusions This is one of the largest series of Pyloromyotomy ever reported. Although laparoscopy is associated with a statistically significant increase in the risk of incomplete Pyloromyotomy, the effect size is small and of questionable clinical relevance. Both OP and LP are associated with low rates of mucosal perforation and incomplete Pyloromyotomy in specialist centers, whether trainee or consultant surgeons perform the procedure.
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Protocol versus ad libitum feeds after laparoscopic Pyloromyotomy: a prospective randomized trial.
Journal of pediatric surgery, 2013Co-Authors: Obinna O. Adibe, Corey W. Iqbal, Susan W. Sharp, David Juang, Charles L. Snyder, George Holcomb, Daniel J. Ostlie, Shawn D. St. PeterAbstract:Abstract Background We conducted a prospective, randomized trial comparing protocol to ad libitum (ad lib) feeding after laparoscopic Pyloromyotomy. Methods Infants undergoing laparoscopic Pyloromyotomy were randomized to protocol versus ad lib feeding strategies. The protocol started with Pedialyte® two hours post-operative. This was repeated by another round of Pedialyte®, then two rounds of half-strength formula or breast milk, followed by two rounds of full strength formula or breast milk, followed by the home feeding regimen, at which time the patient was discharged if feeding well. The ad lib group was allowed formula or breast milk two hours after the operation and considered for discharge after tolerating three consecutive feeds. The primary outcome variable was the length of postoperative hospitalization. Results One hundred fifty infants were enrolled between January 2010 and December 2011. There were no differences in patient characteristics at presentation. While the ad lib group reached goal feeds sooner than the protocol group, this did not translate into a difference in duration of postoperative hospitalization. There were more patients with emesis in the ad lib group after goal feeding was reached, but no difference in readmissions. Conclusion Ad lib feeding allows patients to reach goal feeds more rapidly than protocol feeding following laparoscopic Pyloromyotomy. However, this goal is usually reached beyond discharge hours, resulting in a similar duration of hospitalization.
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predictors of emesis and time to goal intake after Pyloromyotomy analysis from a prospective trial
Journal of Pediatric Surgery, 2008Co-Authors: Shawn D. St. Peter, Susan W. Sharp, George Holcomb, Kuojen Tsao, Daniel J. OstlieAbstract:Background Emesis after Pyloromyotomy for pyloric stenosis is a common clinical phenomenon and the limiting factor in time to goal feeds. The amount of emesis that can be expected after myotomy is unknown. No data have been published that equip caregivers with the ability to understand which patients are more likely to have emesis and take longer to advance to goal feeds after Pyloromyotomy. Therefore, we performed analysis of prospective data obtained from a randomized trial to determine if outcome can be predicted from preoperative or intraoperative variables.
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open versus laparoscopic Pyloromyotomy for pyloric stenosis a prospective randomized trial
Annals of Surgery, 2006Co-Authors: Shawn D. St. Peter, Charles L. Snyder, George Holcomb, Ronald J Sharp, Walter S Andrews, Patrick J Murphy, Casey M Calkins, Daniel J. OstlieAbstract:Background: Pyloric stenosis, the most common surgical condition of infants, is treated by longitudinal myotomy of the pylorus. Comparative studies to date between open and laparoscopic Pyloromyotomy have been retrospective and report conflicting results. To scientifically compare the 2 techniques, we conducted the first large prospective, randomized trial between the 2 approaches. Methods: After obtaining IRB approval, subjects with ultrasound-proven pyloric stenosis were randomized to either open or laparoscopic Pyloromyotomy. Postoperative pain management, feeding schedule, and discharge criteria were identical for both groups. Operating time, postoperative emesis, analgesia requirements, time to full feeding, length of hospitalization after operation, and complications were compared. Results: From April 2003 through March 2006, 200 patients were enrolled in the study. There were no significant differences in operating time, time to full feeding, or length of stay. There were significantly fewer number of emesis episodes and doses of analgesia given in the laparoscopic group. One mucosal perforation and one incisional hernia occurred in the open group. Late in the study, 1 patient in the laparoscopic group was converted to the open operation. A wound infection occurred in 4 of the open patients compared with 2 of the laparoscopic patients (P = 0.68). Conclusions: There is no difference in operating time or length of recovery between open and laparoscopic Pyloromyotomy. However, the laparoscopic approach results in less postoperative pain and reduced postoperative emesis. In addition, there was a fewer number of complications in the laparoscopic group. Finally, patients approached laparoscopically will likely display superior cosmetic outcomes with long-term follow-up.
Oliver J Muensterer - One of the best experts on this subject based on the ideXlab platform.
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the cross technique for single incision pediatric endosurgical Pyloromyotomy
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Oliver J Muensterer, Albert J Chong, Keith E Georgeson, Carroll M HarmonAbstract:Single-incision pediatric endosurgical (SIPES) Pyloromyotomy is frequently used for the treatment of hypertrophic pyloric stenosis at our center. Our initial SIPES approach mirrored the conventional, triangulated laparoscopic Pyloromyotomy. Because an increased number of perforations were noted on our initial analysis, a more straightforward Cross-technique SIPES Pyloromyotomy was developed. This study compares the current Cross-technique SIPES Pyloromyotomy to the previous standard SIPES operation. The Cross-technique entails grasping the antrum with the surgeon’s left hand instrument, retracting toward the left lower quadrant, and thereby orienting the pylorus obliquely toward the right upper quadrant. The serosal incision and muscular spreading is accomplished using a right-hand instrument that crosses over the left hand grasper. Demographic variables, operative times, estimated blood loss (EBL), complications, conversion rate, and postoperative length of stay were compared. Twenty-nine Cross-technique patients were compared with 23 in the standard group. The Cross-technique was faster than the standard procedure (21 ± 5 vs. 27 ± 12 min, p = 0.03) and EBL was lower (1.3 ± 0.5 vs. 1.7 ± 0.6 ml, p = 0.02). There were two mucosal perforations requiring conversions to triangulated 3-access-site laparoscopy in the standard, and one conversion to open surgery in the Cross-technique group. Patients who underwent cross-technique Pyloromyotomy weighed less (3.6 ± 0.6 vs. 4.0 ± 0.5 kg, p = 0.012), but there were no differences in age, gender ratio, conversion rate, or length of stay. There was one postoperative wound infection in the cross-technique, but none in the standard group. No patients required reoperation. All participating surgeons felt that the cross-technique was more ergonomic and easier to perform than the standard SIPES technique. The Cross-technique appears superior to standard SIPES Pyloromyotomy and should be preferentially used for single-incision endosurgical Pyloromyotomy for hypertrophic pyloric stenosis.
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single incision laparoscopic Pyloromyotomy initial experience
Surgical Endoscopy and Other Interventional Techniques, 2010Co-Authors: Oliver J Muensterer, Obinna O. Adibe, Albert J Chong, Carroll M Harmon, Erik N Hansen, Donna T Bartle, Keith E GeorgesonAbstract:Laparoscopic Pyloromyotomy has become the standard treatment for hypertrophic pyloric stenosis. Single-incision laparoscopic surgery is an emerging operative approach that utilizes the umbilical scar to hide the surgical incision. To describe our initial experience with single-incision laparoscopic Pyloromyotomy in 15 infants. Laparoscopic Pyloromyotomy was performed through a single skin incision in the umbilicus, using a 4-mm 30° endoscope and a 5-mm trocar. The 3-mm working instruments were inserted directly into the abdomen via separate lateral fascial stab incisions. All patients were prospectively evaluated. The procedure was performed in 15 infants (13 male) with mean age of 45 ± 16 days and mean weight of 4.04 ± 0.5 kg. All procedures were completed laparoscopically, and one case was converted to a conventional triangulated laparoscopic work configuration after a mucosal perforation was noted. The perforation was repaired laparoscopically. On average, operating time was 29.8 ± 13.6 min, and postoperative length of stay was 1.5 ± 0.8 days. All patients were discharged home on full feeds. Follow-up was scheduled 2–3 weeks after discharge, and no postoperative complications were noted in any of the patients. Single-incision laparoscopic Pyloromyotomy is a safe and feasible procedure with good postoperative results and excellent cosmesis. The main challenge is the spatial orientation of the instruments and endoscope in a small working space. This can be overcome by a more longitudinally oriented working axis than used in the conventional angulated laparoscopic configuration.
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single incision pediatric endosurgical sipes versus conventional laparoscopic Pyloromyotomy a single surgeon experience
Journal of Gastrointestinal Surgery, 2010Co-Authors: Oliver J MuenstererAbstract:Background Pyloromyotomy by single-incision pediatric endosurgery (SIPES) is a new technique that leaves virtually no appreciable scar. So far, it has not been compared to conventional laparoscopic (CL) Pyloromyotomy. This study compares the results of the first 15 SIPES pyloromyotomies of a surgeon to his last 15 CL cases.
