Single-incision laparoscopic surgery for pyloric stenosis.

BACKGROUND: Laparoscopy is the most common procedure for correction of congenital pyloric stenosis. The standard laparoscopic approach is based on the three-port technique. In contrast to the standard laparoscopic technique, the single-incision laparoscopic surgery (SILS) requires only one incision. We report on our experience with this surgical approach. MATERIALS AND METHODS: Between September 2009 and August 2010 a total of 24 children underwent a laparoscopic pyloromyotomy, 12 in SILS technique. The single incision was carried through the center of the umbilicus. The working instruments were introduced in a two-dimensional direction into the peritoneal cavity via the same umbilical incision. The two groups were compared for patients' demographics, operative report and early postoperative outcomes. RESULTS: All SILS procedures were performed successfully with no conversion rate. There were no differences in the preoperative parameters between the two groups regarding age before surgery and body weight at operation. Operative time and time of full enteral intake was similar to comparable procedures with usage of a standard laparoscopic approach. There were no operative or postoperative complications. CONCLUSIONS: The early experience described in this study confirms that SILS can be applied for treatment of pyloric stenosis with outcomes similar to the standard laparoscopic surgery.

SETT--subcutaneous endoscopic transaxillary tenotomy for congenital muscular torticollis.

BACKGROUND: Surgical correction of the congenital muscular torticollis (CMT) is recommended for patients with unsuccessful conservative treatment. Open operative techniques all leave noticeable scars. Tenotomy can be performed endoscopically. We proposed the modified endoscopic two-trocar transaxillary approach for the treatment of CMT. MATERIALS AND METHODS: We have applied a technique of endoscopic release of the sternocleidomastoid (SCM) muscle in 5 pediatric patients. We performed the tunnelization of the space over the clavicular and sternal heads of the SCM muscle applied balloon inflation of the Foley catheter (Fr. 16). The sternal and clavicular attachments were dissected and divided by electrocautery hook. RESULTS: An excellent result was found in all 5 patients. There were no complications to be seen. The neurovascular structures were preserved in all cases. CONCLUSIONS: We believe that the subcutaneous endoscopic transaxcillary tenotomy procedure is a good method for the treatment of congenital muscular torticollis. This endoscopic technique avoids injury to the neurovascular structures and does not leave visible scars.