Laparoscopic pylorotomy

In the 1980s, laparoscopic surgery was applied as an emerging abdominal surgery technique. In 1990, Alain JL first performed pyloric ring myotomy with laparoscopy and was gradually applied. Laparoscopic pyloromyotomy is superior to open surgery in terms of operation time, incision complications, postoperative recovery and average hospitalization days. It is a safe and reliable minimally invasive surgery. Treatment of diseases: pyloric obstruction Indication After the diagnosis, in addition to the symptoms of atypical and lightly ill children can take non-surgical treatment, they should be treated as soon as possible after appropriate preoperative preparation. Contraindications Patients with coagulopathy need surgery before they need surgery. Preoperative preparation Sick children often suffer from chronic dehydration or alkalosis due to frequent vomiting, with varying degrees of malnutrition. Active preoperative preparation must be done for 1 to 2 days to improve the general condition of the patient for safe operation. 1. According to the clinical manifestations of the sick children and blood biochemical examination results, intravenous rehydration, correction of water, electrolytes, acid-base imbalance, if there is convulsions should be appropriate calcium. Transfer plasma or whole blood if necessary. 2. Because most of the sick children have pyloric obstruction, the feeding should be stopped, but it is not necessary to place the gastric tube for continuous decompression. Patients with severe obstructive symptoms were treated with warm saline before surgery to reduce gastric mucosal edema. It is not necessary to keep the stomach tube, and then place the stomach tube in the morning. 3. Actively treat existing comorbidities such as pneumonia. Surgical procedure 1. The stomach contents are evacuated before surgery to prevent the gastric swell from affecting the operation; and to prevent the stomach wall from being damaged by the Veress needle. 2. Establish an arc-shaped incision at the lower edge of the pneumoperitoneum, cut the skin 5mm, clamp the skin on both sides of the incision with a cloth towel, lift the abdominal wall, puncture through the umbilical incision with Veress pneumoperitoneum, confirm the injection of CO2 gas into the abdominal cavity. . The gas flow rate is set at the "2" position to maintain the intra-abdominal pressure at 8 to 10 mmHg. 3. Place the casing (1) After the pneumoperitoneum is successfully lifted, the abdominal wall is lifted, and the 5mm puncture cone is inserted into the abdominal cavity through the umbilical incision, and the cone core is removed. The 30° laparoscope is inserted through the cannula, and the power supply and the monitor are connected to check whether there is bleeding in the abdominal cavity. Intestinal tube damage. (2) The skin was cut 5 mm at the upper part of the umbilical plane and the left and right anterior line respectively. Under the laparoscopic monitoring, the 5 mm puncture cone was used to puncture the abdominal cavity through two incisions, and the cone core was pulled out to leave the sheath tube. 4. Pyloric ring muscle incision: (1) The assistant inserts the non-invasive traction fixed forceps through the left sheath tube, and fixes the stomach wall at the near pylorus. (2) The surgeon inserts the telescopic pylorus muscle incision knife through the right sheath tube, and extends the knife head when approaching the pyloric block. In the avascular region of the pyloric mass, the pylorus is cut from the stomach to the duodenum along its longitudinal axis. Serosal membrane and superficial muscle fibers. (3) Retract the cutter head and use the scalpel to bluntly separate the pyloric muscle to the submucosa. (4) Replace the instrument, insert the pyloric separation forceps through the right sheath, and continue to separate the pyloric muscle until the mucosa is completely bulged. (5) Injecting gas through the gastric tube, and observing under the laparoscope, there is no leakage of the bulging mucosa. If there is damage, it must be repaired with non-invasive line repair or transfer open surgery. complication 1. A small number of children still have vomiting after surgery, usually relieved after 24h, and some last for 2 to 3d, more natural relief. Such as continuous vomiting, the reasons may be: 1 pyloric muscle incision is not complete; 2 pyloric mucosal edema; 3 postoperative gastric dilatation; 4 coexisting gastroesophageal reflux. If vomiting persists for more than 4 weeks, a barium meal examination should be performed to determine the cause of vomiting. The reoperation should be cautious. 2. Because most of the sick children are malnourished, it is more likely to have abdominal wall incision complications, such as abdominal wall incision splitting, incisional hernia, and incision infection. Therefore, the suture technique of each layer of abdominal wall should be paid attention to during operation, and nutritional support should be strengthened after operation. However, the abdominal wall incision complications were significantly less than open surgery.