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Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis-A Systematic Review and Meta-Analysis
Fabian Lunger1, Ralph F Staerkle2, Julian L Muff3
1Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland; Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland.
Insights
This meta-analysis found no significant difference in complication risks between open and laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis. However, the low certainty of evidence means outcomes like infection and recovery time remain unclear.
Area of Science:
- Pediatric Surgery
- Surgical Techniques Comparison
- Gastrointestinal Surgery
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical condition in infants.
- Treatment options include open pyloromyotomy (OP) and laparoscopic pyloromyotomy (LP).
- Comparative effectiveness data between OP and LP for IHPS is crucial for surgical decision-making.
Purpose of the Study:
- To conduct a meta-analysis comparing the outcomes of open pyloromyotomy versus laparoscopic pyloromyotomy for IHPS.
- To evaluate primary outcomes of mucosal perforation and incomplete pyloromyotomy.
- To assess secondary outcomes including hospital stay, feeding times, operative time, and complications.
Main Methods:
- A systematic literature search was performed from 1990 to February 2021 across major electronic databases.
- Seven randomized controlled trials (RCTs) involving 720 infants (357 OP, 363 LP) were included in the meta-analysis.
- Primary outcomes analyzed were mucosal perforation and incomplete pyloromyotomy; secondary outcomes included various postoperative complications and recovery metrics.
Main Results:
- No significant difference in the rate of mucosal perforation between LP and OP (RR 1.60 [0.49-5.26]).
- A trend towards a higher risk of incomplete pyloromyotomy with LP was observed, though not statistically significant (RR 7.37 [0.92-59.11]).
- No significant differences were found in postoperative wound infections, hematoma/seroma formation, or incisional hernias. Length of stay and time to full feeds were nonsignificantly shorter with LP.
Conclusions:
- Current meta-level evidence does not support a higher risk of mucosal perforation or incomplete pyloromyotomy with laparoscopic versus open techniques.
- The certainty of evidence is very low, precluding definitive conclusions on the impact of LP on other postoperative outcomes such as infections, hernias, recovery times, and operative duration.
- Further high-quality research is needed to clarify the comparative safety and efficacy of laparoscopic pyloromyotomy for IHPS.
Introduction:
Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the open versus laparoscopic technique.
Methods:
A literature search was conducted from 1990 to February 2021 using the electronic databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Primary outcomes were mucosal perforation and incomplete pyloromyotomy. Secondary outcomes consisted of length of hospital stay, time to full feeds, operating time, postoperative wound infection/abscess, incisional hernia, hematoma/seroma formation, and death.
Results:
Seven randomized controlled trials including 720 patients (357 with OP and 363 with LP) were included. Mucosal perforation rate was not different between groups (relative risk [RR] LP versus OP 1.60 [0.49-5.26]). LP was associated with nonsignificant higher risk of incomplete pyloromyotomy (RR 7.37 [0.92-59.11]). There was no difference in neither postoperative wound infections after LP compared with OP (RR 0.59 [0.24-1.45]) nor in postoperative seroma/hematoma formation (RR 3.44 [0.39-30.43]) or occurrence of incisional hernias (RR 1.01 [0.11-9.53]). Length of hospital stay (-3.01 h for LP [-8.39 to 2.37 h]) and time to full feeds (-5.86 h for LP [-15.95 to 4.24 h]) were nonsignificantly shorter after LP. Operation time was almost identical between groups (+0.53 min for LP [-3.53 to 4.59 min]).
Conclusions:
On a meta-level, there is no precise effect estimate indicating that LP carries a higher risk for mucosal perforation or incomplete pyloromyotomies compared with the open equivalent. Because of very low certainty of evidence, we do not know about the effect of the laparoscopic approach on postoperative wound infections, postoperative hematoma or seroma formation, incisional hernia occurrence, length of postoperative stay, time to full feeds, or operating time.
