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Published on: June 17, 2018
Open versus laparoscopic pyloromyotomy for pyloric stenosis: a meta-analysis of randomized controlled trials
1Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, China.
Insights
Laparoscopic pyloromyotomy (LP) and open pyloromyotomy (OP) are equally safe and effective for infantile pyloric stenosis. While complications were similar, LP showed a trend toward shorter recovery times.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of non-bilious vomiting in infants.
- Surgical correction, typically pyloromyotomy, is the definitive treatment.
Purpose of the Study:
- To compare the safety and efficacy of laparoscopic pyloromyotomy (LP) versus open pyloromyotomy (OP) for IHPS.
- To analyze complication rates and time-related outcomes between the two surgical approaches.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing LP and OP.
- Searches conducted in multiple databases up to February 2009.
- Outcomes analyzed included wound infection, mucosal perforation, incisional hernia, granuloma, incomplete pyloromyotomy, vomiting, and time-related metrics.
Main Results:
- Three RCTs with 492 infants were included.
- No significant differences in complication rates (wound infection, perforation, hernia, incomplete procedure, vomiting, total complications) between LP and OP.
- While most time-related outcomes (time to feeds, length of stay, operating time) showed no significant difference, one study indicated shorter times for LP.
Conclusions:
- Both open and laparoscopic pyloromyotomy are safe and effective for infantile pyloric stenosis.
- Limited high-quality trials were available, with some heterogeneity noted.
- Laparoscopic pyloromyotomy may offer a trend towards shorter time-related recovery outcomes.
Objective:
Aim of the study was to compare the outcomes after laparoscopic pyloromyotomy (LP) with those of open pyloromyotomy (OP) for infantile pyloric stenosis.
Method:
We conducted searches until February 2009 in multiple databases and identified randomized controlled trials comparing LP with OP for pyloric stenosis. Results were expressed using the odds ratio (OR) for categorical variables and standard weighted mean differences (SMD) for continuous outcomes. Study quality was assessed using the Cochrane Handbook 5.0.1 guidelines and statistical analysis was performed using RevMan 5.0.8 software.
Results:
3 studies totaling 492 infants were included. The results showed no significant differences in complications between the groups with regard to wound infection (OR: 1.77, 95% CI 0.58-5.35), mucosal perforations (OR: 0.96, 95% CI: 0.22-4.26), incisional hernia or granuloma (OR: 1.39, 95% CI: 0.41-4.73), incomplete pyloromyotomy (OR: 0.13, 95% CI: 0.02-1.07), substantial vomiting (OR: 0.67, 95% CI: 0.30-1.52) and total complications (OR: 0.91, 95% CI: 0.54-1.53). Although the combined result of 2 studies also indicated an insignificant discrepancy in time-related outcomes for full time to feeds, length of stay after surgery and operating time (SMD: 0.78, 95% CI: -0.50-2.06; SMD: 1.27, 95% CI: -1.56-4.10; SMD: -0.46, 95% CI: -1.11-0.20, respectively), another study indicated shorter times for LP procedures (p=0.002, 0.027, and 0.008, respectively).
Conclusions:
Only a few trials were available for analysis. Heterogeneity was seen between studies, but the available trials were of high quality. The present study shows that both OP and LP are equally safe and effective procedures for the management of pyloric stenosis in children. However, there was a trend in LP toward shorter time time-related outcomes.
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