Standardized laparoscopic pyloromyotomy may reduce the impact of surgeon experience: a comparative study

Laparoscopic pyloromyotomy (LP) is performed widely for hypertrophic pyloric stenosis (HPS); however, few studies have compared the postoperative recovery and surgeon experience associated with LP and open pyloromyotomy (OP) in Japan. We conducted this study to compare the outcomes of OP and LP and to evaluate the impact of surgeon experience on these outcomes.

The subjects of this retrospective analysis were 103 infants who underwent pyloromyotomy (OP group, n = 27; LP group, n = 76) for HPS at one of two institutions between 2014 and 2025. We evaluated intraoperative factors, recovery parameters, and complications. Operators were categorized as trainee surgeons or senior surgeons. Outcomes were analyzed according to the surgical approach.

Patient characteristics were comparable. Operative time was significantly shorter and time to first feeding was shorter in the LP group, but time to full feeding, postoperative vomiting, and hospital length of stay did not differ significantly between the groups. There were no reoperations or Clavien-Dindo grade > III complications. The operative time for trainee surgeons was significantly longer than that for senior surgeons in the OP group, but there was no difference between trainee and senior surgeons in the LP group.

Under a standardized operative protocol, LP may reduce the apparent effect of surgeon experience on operative time in an appropriately supervised setting, supporting its educational value in pediatric surgical training.