Laparoscopic pyloromyotomy: Lessons learnt in our first 101 cases

Quality Assessment of YouTube Videos on Laparoscopic Pyloromyotomy Using a Validated Tool: An Appeal to Trainees to Follow the Peer-Reviewed Videos for Learning Purposes

Background: Surgical trainees often resort to operative videos on the internet during preparation for surgery; YouTube is the most commonly explored video source by them. However, the quality of these videos is often questioned. This study was performed to assess the quality of available YouTube videos on laparoscopic pyloromyotomy (LP). Materials and Methods: The term "laparoscopic pyloromyotomy" was searched on YouTube on June 2, 2021, and 20 most-viewed videos on LP were included. A reference video on LP from WebSurg was also selected. The laparoscopic surgery video educational guidelines (LAP-VEGaS) tool was utilized for quality assessment of these videos. Descriptive variables, including the surgeon's details; year of video upload; duration of the video; view, like, and dislike counts; number of ports used; and instruments used for pyloromyotomy, were recorded and their relationship with video quality was studied. Results: The majority of videos were from the United States and India, and a surgeon could be identified in 90% of them. The median (range) video duration and view, like, and dislike counts were 2.89 (0.68-8.80) minutes, 2308 (1102-23,682), 5 (0-59), and 0 (0-11), respectively. The LAP-VEGaS score of the reference video was 17. In contrast, the scores of YouTube videos ranged from 1 to 14. The quality of these videos was poor in 5/9 domains. None of the descriptive variables showed a significant association with high video quality. Conclusion: Compared with the reference video, the overall quality of YouTube videos on LP was poor. Therefore, until a screening tool is available for selection of high-quality YouTube videos, trainees must resort to peer-reviewed video platforms.

Open versus laparoscopic pyloromyotomy for pyloric stenosis

BACKGROUND

Infantile hypertrophic pyloric stenosis (IHPS) is a disorder of young children (aged one year or less) and can be treated by laparoscopic (LP) or open (OP) longitudinal myotomy of the pylorus. Since the first description in 1990, LP is being performed more often worldwide.

OBJECTIVES

To compare the efficacy and safety of open versus laparoscopic pyloromyotomy for IHPS.

SEARCH METHODS

We conducted a literature search on 04 February 2021 to identify all randomised controlled trials (RCTs), without any language restrictions. We searched the following electronic databases: MEDLINE (1990 to February 2021), Embase (1990 to February 2021), and the Cochrane Central Register of Controlled Trials (CENTRAL). We also searched the Internet using the Google Search engine (www.google.com) and Google Scholar (scholar.google.com) to identify grey literature not indexed in databases.

SELECTION CRITERIA

We included RCTs and quasi-randomised trials comparing LP with OP for hypertrophic pyloric stenosis.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened references and extracted data from trial reports. Where outcomes or study details were not reported, we requested missing data from the corresponding authors of the primary RCTs. We used a random-effects model to calculate risk ratios (RRs) for binary outcomes, and mean differences (MDs) for continuous outcomes. Two review authors independently assessed risks of bias. We used GRADE to assess the certainty of the evidence for all outcomes.

MAIN RESULTS

The electronic database search resulted in a total of 434 records. After de-duplication, we screened 410 independent publications, and ultimately included seven RCTs (reported in 8 reports) in quantitative analysis. The seven included RCTs enrolled 720 participants (357 with open pyloromyotomy and 363 with laparoscopic pyloromyotomy). One study was a multi-country trial, three were carried out in the USA, and one study each was carried out in France, Japan, and Bangladesh. The evidence suggests that LP may result in a small increase in mucosal perforation compared with OP (RR 1.60, 95% CI 0.49 to 5.26; 7 studies, 720 participants; low-certainty evidence). LP may result in up to 5 extra instances of mucosal perforation per 1,000 participants; however, the confidence interval ranges from 4 fewer to 44 more per 1,000 participants. Four RCTs with 502 participants reported on incomplete pyloromyotomy. They indicate that LP may increase the risk of incomplete pyloromyotomy compared with OP, but the confidence interval crosses the line of no effect (RR 7.37, 95% CI 0.92 to 59.11; 4 studies, 502 participants; low-certainty evidence). In the LP groups, 6 cases of incomplete pyloromyotomy were reported in 247 participants while no cases of incomplete pyloromyotomy were reported in the OP groups (from 255 participants). All included studies (720 participants) reported on postoperative wound infections or abscess formations. The evidence is very uncertain about the effect of LP on postoperative wound infection or abscess formation compared with OP (RR 0.59, 95% CI 0.24 to 1.45; 7 studies, 720 participants; very low-certainty evidence). The evidence is also very uncertain about the effect of LP on postoperative incisional hernia compared with OP (RR 1.01, 95% CI 0.11 to 9.53; 4 studies, 382 participants; very low-certainty evidence). Length of hospital stay was assessed by five RCTs, including 562 participants. The evidence is very uncertain about the effect of LP compared to OP (mean difference -3.01 hours, 95% CI -8.39 to 2.37 hours; very low-certainty evidence). Time to full feeds was assessed by six studies, including 622 participants. The evidence is very uncertain about the effect of LP on time to full feeds compared with OP (mean difference -5.86 hours, 95% CI -15.95 to 4.24 hours; very low-certainty evidence). The evidence is also very uncertain about the effect of LP on operating time compared with OP (mean difference 0.53 minutes, 95% CI -3.53 to 4.59 minutes; 6 studies, 622 participants; very low-certainty evidence).

AUTHORS' CONCLUSIONS

Laparoscopic pyloromyotomy may result in a small increase in mucosal perforation when compared with open pyloromyotomy for IHPS. There may be an increased risk of incomplete pyloromyotomy following LP compared with OP, but the effect estimate is imprecise and includes the possibility of no difference. We do not know about the effect of LP compared with OP on the need for re-operation, postoperative wound infections or abscess formation, postoperative haematoma or seroma formation, incisional hernia occurrence, length of postoperative stay, time to full feeds, or operating time because the certainty of the evidence was very low for these outcomes. We downgraded the certainty of the evidence for most outcomes due to limitations in the study design (most outcomes were susceptible to detection bias) and imprecision. There is limited evidence available comparing LP with OP for IHPS. The included studies did not provide sufficient information to determine the effect of training, experience, or surgeon preferences on the outcomes assessed.

Guidelines of the Italian Society of Videosurgery (SIVI) in Infancy for the minimally invasive treatment of Hypertrophic Pyloric Stenosis in neonates and infants

The most appropriate treatment for the infantile Hypertrophic Pyloric Stenosis (HPS) is still debated. The non-surgical conservative treatment with oral or intravenous administration of atropine does not enjoy a widespread appreciation for several factors (...).