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Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis
Chethan Sathya1, Carolyn Wayne1, Anna Gotsch1
1Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
Insights
Comparing open and laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis, this study found no significant differences in major complications or operative outcomes. The choice between open and laparoscopic surgery should remain with the surgeon.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Hypertrophic pyloric stenosis (HPS) is a common surgical condition in infants.
- Pyloromyotomy is the definitive treatment for HPS.
- Both open and laparoscopic approaches are utilized for pyloromyotomy.
Purpose of the Study:
- To compare the efficacy and safety of open versus laparoscopic pyloromyotomy in infants with HPS.
- To determine if one surgical approach offers superior outcomes.
Main Methods:
- A systematic review and meta-analysis of comparative studies.
- Searched databases including MEDLINE, EMBASE, and CENTRAL.
- Analyzed primary outcomes (major complications) and secondary outcomes (perioperative complications, operative time, length of stay, time to feeds, pyloromyotomy adequacy, cosmetic outcome).
Main Results:
- No significant differences were found in major complications, perioperative complications, operative time, or length of stay between open and laparoscopic pyloromyotomy.
- Laparoscopic pyloromyotomy was associated with a faster return to full feeds.
- A slightly higher rate of inadequate pyloromyotomy was observed with laparoscopy, and one study suggested better cosmetic outcomes with the laparoscopic approach.
Conclusions:
- Current evidence does not strongly favor either open or laparoscopic pyloromyotomy for HPS.
- The choice of surgical technique should be based on surgeon preference and patient factors.
- Further research may clarify long-term outcomes and cosmetic results.
Purpose:
To determine whether open or laparoscopic pyloromyotomy is superior for the treatment of hypertrophic pyloric stenosis in infants.
Methods:
We searched MEDLINE, EMBASE, and CENTRAL for articles comparing laparoscopic and open procedures. We conducted meta-analyses when possible and described other results narratively.
Results:
Our meta-analyses revealed no significant difference in our primary outcome of major complications [risk difference (RD) 0.03, 95% confidence interval (CI) -0.03 to 0.08, P = 0.35, I 2 = 55%], or in our secondary outcomes of all perioperative complications (RD -0.01, 95% CI -0.06 to 0.04, P = 0.74, I 2 = 0%), operative time [mean difference (MD) 0.68, 95% CI -3.60 to 4.79, P = 0.76, I 2 = 86%], and length of stay (MD -2.60, 95% CI -6.05 to 0.86, P = 0.14, I 2 = 0%). Laparoscopy was associated with a shorter time to full feeds (standardized mean difference -0.25, 95% CI -0.43 to -0.06, P = 0.009, I 2 = 8%) and a slightly higher rate of inadequate pyloromyotomy (RD 0.04, 95% CI 0.00-0.08, P = 0.03, I 2 = 0%). Results from one randomized controlled trial indicate a better cosmetic outcome after laparoscopy compared to open procedure.
Conclusion:
There is no strong evidence to support a recommendation of one procedure over the other; therefore, the choice of laparoscopic or open procedure should be left to the discretion of the surgeon.
