Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Hypertrophic pyloric stenosis (HPS) is a common condition in infants.
• Surgical correction, pyloromyotomy, is the standard treatment.
• Laparoscopic pyloromyotomy (LP) has emerged as an alternative to open pyloromyotomy (OP).

Purpose of the Study:

• To compare the effectiveness of laparoscopic pyloromyotomy (LP) versus open pyloromyotomy (OP) in infants with HPS.
• To evaluate key outcomes including complication rates, operative time, and recovery parameters.

Main Methods:

• A systematic review and meta-analysis of prospective studies comparing LP and OP.
• Data extraction included age, weight, complications, operative duration, feeding times, vomiting, and length of stay (LOS).
• Six studies (5 level I, 1 level II) with 625 infants were analyzed.

Main Results:

• LP was associated with a significantly lower total complication rate (OR, 0.58) and wound complication rate (OR, 0.42).
• Patients undergoing LP experienced shorter time to full feedings (MD, -11.52 hours) and reduced postoperative LOS (MD, -5.71 hours).
• No significant differences were found in mucosal perforation, wound infection, postoperative emesis, or operating time; however, incomplete pyloromyotomy was more frequent with LP (OR, 7.74).

Conclusions:

• The laparoscopic approach for pyloromyotomy in infants with HPS is favored due to a significantly reduced overall complication rate, primarily driven by fewer wound complications.
• LP offers faster recovery, evidenced by quicker return to full feedings and shorter hospital stays.
• While LP shows advantages, careful consideration of the potential for incomplete pyloromyotomy is warranted.