Cosper Graham H, Menon Rema, Hamann Mary Sue, Nakayama Don K
University of North Carolina School of Medicine, Coastal Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC 28402-9025, USA.
J Pediatr Surg. 2008 Jan;43(1):102-8. doi: 10.1016/j.jpedsurg.2007.09.029.
Both pediatric and general surgeons perform pyloromyotomy. Laparoscopic pyloromyotomy (LAP), and changes in referral patterns have affected the training of pediatric surgery fellows and general surgery residents. We surveyed pediatric surgeons regarding these issues.
We mailed an Institutional Review Board of New Hanover Regional Medical Center-approved survey to 701 members of the American Pediatric Surgical Association within the United States to determine each surgeon's preferred technique for pyloromyotomy (LAP vs Ramstedt or transumbilical procedures [OPEN]), practice setting, involvement with trainees, and opinions regarding pyloromyotomy. Significance was determined using chi(2) analyses.
A total of 331 (48%) surgeons responded: 197 (60%) performed most or all OPEN, and 85 (26%), most or all LAP. Laparoscopic pyloromyotomy was more likely in academic practices and children's hospitals (P < .05). Residents under surgeons performing LAP were less likely to participate (58% vs 91%; P < .05) or gain competence (22% vs 42%; P < .5). Only 34% of surgeons performing LAP believed that general surgery residents should learn pyloromyotomy, whereas 67% of surgeons performing OPEN believed that residents should learn the procedure (P < .05). A total of 307 (93%) surgeons believed at least 4 OPEN were necessary to become competent, but 126 (44%) reported that their residents performed fewer than 4. Only 104 (31%) surgeons believed that their residents were competent in pyloromyotomy. There were 303 (92%) surgeons who believed that pyloromyotomy should be performed only by pediatric surgeons when possible.
Most general surgical residents are not learning pyloromyotomy, in part because of the adoption of laparoscopic technique, limited operative experience, and the opinion of most pediatric surgeons that the procedure should be performed only by pediatric surgeons.
小儿外科医生和普通外科医生均会实施幽门肌切开术。腹腔镜幽门肌切开术（LAP）以及转诊模式的变化影响了小儿外科住院医师和普通外科住院医师的培训。我们就这些问题对小儿外科医生进行了调查。
我们向美国境内701名美国小儿外科协会成员邮寄了一份经新汉诺威地区医疗中心机构审查委员会批准的调查问卷，以确定每位外科医生首选的幽门肌切开术技术（LAP与拉姆施泰特术式或经脐手术[开放式]）、执业环境、对实习生的指导参与情况以及对幽门肌切开术的看法。采用卡方分析确定显著性。
共有331名（48%）外科医生回复：197名（60%）实施了大部分或全部开放式手术，85名（26%）实施了大部分或全部腹腔镜手术。在学术机构和儿童医院，实施腹腔镜幽门肌切开术的可能性更大（P<.05）。在实施腹腔镜手术的外科医生指导下的住院医师参与手术的可能性较小（58%对91%；P<.05）或获得操作能力的可能性较小（22%对42%；P<.5）。仅34%实施腹腔镜手术的外科医生认为普通外科住院医师应学习幽门肌切开术，而67%实施开放式手术的外科医生认为住院医师应学习该手术（P<.05）。共有307名（93%）外科医生认为至少需要进行4例开放式手术才能胜任，但126名（44%）报告称其住院医师实施的手术少于4例。仅104名（31%）外科医生认为其住院医师具备幽门肌切开术的操作能力。共有303名（92%）外科医生认为幽门肌切开术在可能的情况下应仅由小儿外科医生实施。
大多数普通外科住院医师未学习幽门肌切开术，部分原因是腹腔镜技术的采用、手术经验有限以及大多数小儿外科医生认为该手术应仅由小儿外科医生实施。
