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Updated: Mar 1, 2026
Surgical Management of Meatal Stenosis with Meatoplasty
Published on: November 30, 2010
Population-level surgical outcomes for infantile hypertrophic pyloric stenosis
Nick Lansdale1, Nadeem Al-Khafaji2, Patrick Green1
1Alder Hey Children's Hospital, Liverpool, UK.
Insights
Pyloromyotomy outcomes in infants were not affected by hospital type or patient volume. Laparoscopic surgery for pyloric stenosis showed a higher reoperation risk, suggesting quality benchmarks are needed.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Healthcare Quality Improvement
Background:
- Pyloromyotomy is a common surgical procedure for infantile hypertrophic pyloric stenosis.
- Understanding factors influencing surgical outcomes is crucial for improving patient care.
Purpose of the Study:
- To evaluate national outcomes of pyloromyotomy.
- To assess the impact of surgical approach (open vs. laparoscopic) and center characteristics (type and volume) on outcomes.
- To establish quality benchmarks for pyloromyotomy.
Main Methods:
- Analysis of Hospital Episode Statistics data from 2002-2011.
- Comparison of outcomes between specialist centers (SpCen) and non-specialist centers (NonSpCen).
- Evaluation of reoperation rates based on surgical approach and center volume.
Main Results:
- Over 9,600 infants underwent pyloromyotomy, with a trend towards increased procedures in specialist centers.
- Reoperation rates were similar between specialist and non-specialist centers (1.4% vs. 1.6%).
- Laparoscopic pyloromyotomy was associated with an increased risk of repeat pyloromyotomy (OR 2.28).
Conclusions:
- Pyloromyotomy outcomes are not significantly influenced by center type or volume.
- The potential benefits of laparoscopic pyloromyotomy may be offset by a higher risk of repeat surgery.
- A quality benchmark for reoperation rates below 4% is proposed.
Objectives:
Determine national outcomes for pyloromyotomy; how these are affected by: (i) surgical approach (open/laparoscopic), or (ii) centre type/volume and establish potential benchmarks of quality.
Methods:
Hospital Episode Statistics data were analysed for admissions 2002-2011. Data presented as median (IQR).
Results:
9686 infants underwent pyloromyotomy (83% male). Surgery was performed in 22 specialist (SpCen) and 39 nonspecialist centres (NonSpCen). The proportion treated in SpCen increased linearly by 0.4%/year (r=0.76, p=0.01). Annual case volume in SpCen vs. NonSpCen was 40 (24-53) vs. 1 (0-3). Time to surgery was shorter in SpCen (1day [1, 2] vs. 2 [1-3]), but total stay equal (4days [3-6]). 137 (1.4%) had complications requiring reoperation (wound problem 0.6%; repeat pyloromyotomy 0.5% and perforation, bleeding or obstruction 0.2%): pooled rates were similar between SpCen and NonSpCen (1.4% vs. 1.6%, p=0.52). Three NonSpCen had >5% reoperations (within 99.8% C.I. as small denominators). There was no relationship between reoperation and centre volume. Laparoscopic pyloromyotomy had increased risk of repeat pyloromyotomy (OR 2.28 [1.14-4.57], p=0.029).
Conclusions:
Pyloric stenosis surgery shifted from centres local to patients, but outcomes were unaffected by centre type/volume. Modest reported benefits of laparoscopy appear offset by increased reoperations. Quality benchmarks could be set for reoperation <4%.
Type Of Study:
Treatment Study.
Level Of Evidence:
Level III.
