Minimally Invasive Versus Open Pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis: Insights from an Updated...

Background: Infantile hypertrophic pyloric stenosis represents one of the most prevalent gastrointestinal disorders in infants. It presents with severe persistent vomiting and electrolyte imbalance. Pyloromyotomy is the gold standard approach in the management of pyloric stenosis. The laparoscopic approach provides a reliable and safe alternative to the open technique. We aimed to compare the surgical outcomes of both approaches and determine which approach is superior to the other. Methods: We searched for relevant articles by searching Scopus, Web of Science, PubMed, and the Cochrane Library until January 2025. The Cochrane risk of bias tool was utilized to assess the quality of the clinical trials, whereas the ROBINS-I tool was used in the observational studies. Our primary outcomes were operation time, length of hospital stay, time needed for full feeding, incidence of incomplete pyloromyotomy, mucosal perforation, wound infection, postoperative vomiting, postoperative incisional hernia, postoperative seroma or hematoma formation, need for reoperation, and rate of conversion to P in the laparoscopic group. Results: We included 12 eligible articles that compared laparoscopic pyloromyotomy with open pyloromyotomy in infants with hypertrophic pyloric stenosis. Our analysis revealed comparable results for both procedures in terms of operation time (p = 0.83), hospitalization duration (p = 0.06), mucosal perforation (p = 0.49), postoperative complications such as vomiting (p = 0.10), incisional hernia (p = 0.60), seroma (p = 0.52), and reoperation rates (p = 0.17). Patients who underwent LP achieved full feeding in less time (p = 0.007) and had fewer wound infections (p = 0.01) compared to OP. However, the incidence of incomplete pyloromyotomy was lower in the OP group than in the LP group (p = 0.03). Conclusions: Both open and laparoscopic pyloromyotomy are effective for treating hypertrophic pyloric stenosis. The laparoscopic approach offers the advantages of a faster return to full feeding and lower wound infection rates but increases the risk of incomplete pyloromyotomy compared to the open technique. Surgeon preference and experience play crucial roles in surgical outcomes, provided that there is a thorough understanding of the benefits and limitations of both techniques.