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Laparoscopic versus open pyloromyotomy for infantile hypertropic pyloric stenosis: an early experience
1Department of Peadiatric Surgery, Mymensingh Medical College & Hospital, Mymensingh, Bangladesh.
Insights
Laparoscopic pyloromyotomy is not superior or as safe as open pyloromyotomy for beginners treating infantile hypertrophic pyloric stenosis. This study found no significant differences in recovery or complication rates between the two surgical methods.
Area of Science:
- Pediatric Surgery
- Surgical Techniques
- Infant Health
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical condition in infants.
- Pyloromyotomy is the standard surgical treatment for IHPS.
- Laparoscopic surgery is increasingly adopted, but its safety and efficacy in IHPS require evaluation, especially for novice surgeons.
Purpose of the Study:
- To compare the outcomes of laparoscopic pyloromyotomy versus open pyloromyotomy in infants with IHPS.
- To evaluate operative time, feeding recovery, hospital stay, and complication rates between the two surgical approaches.
- To assess the safety and efficacy of laparoscopic pyloromyotomy for surgeons with initial experience.
Main Methods:
- A prospective comparative study involving 60 infants diagnosed with IHPS.
- Patients were randomly assigned to either laparoscopic pyloromyotomy (Group A, n=30) or open pyloromyotomy (Group B, n=30).
- Data collected included operative time, time to full feeds, postoperative hospital stay, and peri/postoperative complications.
Main Results:
- Operative time was significantly longer in the laparoscopic group (61.59±51.73 min) compared to the open group (28.33±8.40 min) (P=0.001).
- No statistically significant differences were observed in the time to full feeds (P=0.342) or postoperative hospital stay (P=0.355).
- Perioperative and postoperative complication rates showed no significant differences between the groups, although the laparoscopic group had a higher incidence of certain complications.
Conclusions:
- Laparoscopic pyloromyotomy, in the initial experience of surgeons, was not found to be superior or as safe as the traditional open pyloromyotomy for treating infantile hypertrophic pyloric stenosis.
- Further studies with experienced surgeons are needed to establish the benefits of laparoscopic approach in IHPS.
- Beginner surgeons should exercise caution when adopting laparoscopic pyloromyotomy for IHPS due to comparable outcomes and potential for increased operative time and complications.
Abstract:
This prospective comparative study was conducted with an initial experience in the Department of Pediatric Surgery, Dhaka Shishu (Children) Hospital during the period of December 2007 to January 2009, with the infants of 2-12 weeks age, diagnosed as Hypertrophic pyloric stenosis. Patients selection was done by simple random technique by means of lottery. For open pyloromyotomy conventional method & for laparoscopic pyloromyotomy three trocher techniques was applied. In this study, among 60 cases with infantile hypertrophic pyloric stenosis, 30 cases were finally selected for analysis irrespectively both in laparoscopic (Group A) & in open pyloromyotomy (Group B) group. Patients were studied under variables of operative time, required time of full feeds after operation, post operative hospital stay & both per and post operative complications. Regarding operative time, in Group A, mean±SD operating time (in minutes) was 61.59±51.73 whereas in Group B it was 28.33±8.40 & P value was 0.001. The result was statistically significant. The mean±SD time (in hours) of full feeds (ad libitum) was 35.00±31.70 hours in Group A compared to 28.95±10.99 hours in Group B and P value was found 0.342ns which was not statistically significant. On study of total length (in days) of post operative hospital stay, mean±SD was 3.09±2.25 & 2.58±1.15days in laparoscopic group & open pyloromyotomy group respectively. The p value was 0.355ns, which was statistically insignificant. Again, on study of complications, per operatively 6(19.5%) patients had developed haemorrage, 1(3.33%) had mucosal perforation & 4(13.36%) had developed duodenal serosal injury in laparoscopic group whereas only 1(3.33%) patient in open pyloromyotomy group had nothing else except simple hemorrhage. The p value (0.051ns) was also statistically insignificant. In regard to post operative complications, 2(6.6%) patients had developed wound hematoma, 2(6.6%) had wound infection, 1(3.33 %) had developed wound dehiscence and incisional hernia respectively in Group A. But in group B there was no subject with any complication. This result was also statistically insignificant. So, the overall study results denote that, laparoscopic pyloromyotomy would not be considered as a superior procedure or as safe as that of traditional open pyloromyotomy for the beginners.
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