Open versus laparoscopic pyloromyotomy for pyloric stenosis

Area of Science:

• Pediatric Surgery
• Gastrointestinal Surgery
• Evidence-Based Medicine

Background:

• Infantile hypertrophic pyloric stenosis (IHPS) affects infants under one year old.
• Treatment options include laparoscopic (LP) and open (OP) longitudinal myotomy.
• LP has become increasingly common worldwide since its introduction in 1990.

Purpose of the Study:

• To compare the efficacy and safety of laparoscopic pyloromyotomy versus open pyloromyotomy for IHPS.
• To synthesize evidence from randomized controlled trials (RCTs) on surgical outcomes.

Main Methods:

• Comprehensive literature search of RCTs and quasi-randomized trials comparing LP and OP for IHPS, conducted up to February 2021.
• Inclusion criteria focused on trials comparing LP with OP for hypertrophic pyloric stenosis.
• Data extraction and risk of bias assessment were performed independently by two reviewers; GRADE methodology was used to assess evidence certainty.

Main Results:

• Seven RCTs involving 720 participants were included.
• Laparoscopic pyloromyotomy (LP) showed a potential small increase in mucosal perforation risk compared to open pyloromyotomy (OP) (low-certainty evidence).
• Evidence regarding incomplete pyloromyotomy, wound infections, incisional hernia, hospital stay, time to feeds, and operating time was very uncertain due to low-certainty evidence and imprecision.

Conclusions:

• Laparoscopic pyloromyotomy (LP) may slightly increase the risk of mucosal perforation in IHPS patients compared to open pyloromyotomy (OP).
• The risk of incomplete pyloromyotomy may be higher with LP, but the evidence is imprecise.
• Insufficient evidence exists to definitively conclude on the comparative effects of LP versus OP for other critical outcomes, necessitating further high-quality research.