PMC6874506_01
(
A
) Operative photos showing the ports position in Tan's approach where A is umbilical port (telescope), B is duodenal grasper, and C is knife and spreader. (
B
) Operative photo of laparoscopic view showing the myringotomy knife incising the pyloric mass of the pylorus. (
C
) Operative photo of laparoscopic view after complete pyloromyotomy with shoe shine maneuver showing the incised thickened muscle with no obstruction with clear mucosa.
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Right upper quadrant incision of the abdomen for duodenal grasper and left upper quadrant of the abdomen for knife and spreader were performed ( Fig. 1A ). Complete pyloromyotomy was performed ( Fig. 1B and C ).
(
A
) Radiologic photograph of abdomen with oral contrast postoperatively showing the retained contrast in the stomach. (
B
) Operative photo in the second surgery shows cleavage of the Ladd's band.
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Therefore, 4 days later a contrast study was done that was nonconclusive as it showed delayed passage of the contrast material to small intestine ( Fig. 2A ). After conversion to an open procedure due to vital instability, a Ladd's procedure was done ( Fig. 2B ).