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Published on: February 16, 2024
Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis
1Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA. jsola@med.miami.edu
Insights
Laparoscopic pyloromyotomy (LP) is more effective than open pyloromyotomy (OP) for infants with hypertrophic pyloric stenosis, showing fewer complications and faster recovery. This surgical approach offers significant benefits for infant care.
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.
Purpose:
The aim of the study was to determine whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the most effective intervention in infants with hypertrophic pyloric stenosis.
Methods:
A systematic review of the published literature was undertaken in February 2009. Prospective studies comparing LP and OP were selected. Age, weight, complications, duration of operation, time to full feedings, postoperative vomiting, and postoperative length of stay (LOS) data were extracted.
Results:
Six prospective studies (5 level I, 1 level II) with 625 (303 LP, 322 OP) participants met selection criteria. Combined estimates indicated that LP had a lower total complication rate (odds ratio [OR], 0.58 [0.35, 0.97]; P = .04), mostly due to a lower wound complication rate (OR, 0.42 for LP [0.20, 0.91]; P = .03). Patients who underwent LP also had shorter time to full feedings (mean difference [MD], -11.52 hours [-12.77, -10.27]; P < .00001) and shorter postoperative LOS (MD, -5.71 hours [-8.90, -2.52]; P = .0005). No statistically significant differences were noted in the rates of mucosal perforation, wound infection, postoperative emesis, or operating time. Incomplete pyloromyotomy occurred in 6 patients who underwent LP (OR, 7.74 [0.94, 63.38]; P = .06).
Conclusions:
This meta-analysis favors the laparoscopic approach with significantly reduced rate of total complications, which is mostly due to a lower wound complication rate.
