Background/Purpose: Laparoscopic pyloromyotomy gained wide popularity in management of pyloric stenosis with contradictory results regarding its benefits over classic open approach. This study aimed at comparing both regarding their safety, efficiency, and outcome. Methods: This is a prospective randomized controlled study performed from April 2017 to April 2019. It included 80 patients, divided randomly into two groups, where laparoscopic pyloromyotomy was performed in group A and open pyloromyotomy in group B. Both groups were compared regarding operative time, post-operative pain score, time required to reach full feeding, hospital stay, complications, and parents' satisfaction. Results: Median operative time was 21 min in group A vs. 30 min in group B (P = 0). Pain Assessment in Neonates scores were generally higher in group B with more doses of analgesics required (P = 0). Mean time needed to reach full feeding was 15.2 and 18.8 h in groups A and B, respectively (P = 0). Median hospital stay was 19 h in group A and 22 h in group B (P = 0.004). Parents' satisfaction also was in favor of group A (P = 0.045). Although no significant difference was reported between both groups regarding early and late complications, some complications such as mucosal perforation and incomplete pyloromyotomy occurred in the laparoscopic group only. Conclusion: Laparoscopic pyloromyotomy was found superior to open approach regarding faster operative time, less need of analgesics, easier development of oral feeding, shorter hospital stay, and better parents' satisfaction. Yet, there are still some concerns about the safety and efficiency of this procedure over open technique.

Carbonic anhydrase can be said to be the key factor responsible for reduction of hepatic glucose production. Thus carbonic anhydrase could serve as a new therapeutic target for reducing hepatic glucose production.

Background: Carbonic Anhydrase (CA) is a zinc metallo-enzyme that is critical to regulation of systemic acid-base homeostasis by facilitating urinary acidification. Inhibition of carbonic anhydrase results in metabolic acidosis which leads to decrease in pH.

Carbonic anhydrase is a pH regulatory enzyme, whose inhibition leads to metabolic acidosis. We investigated whether carbonic anhydrase inhibition may be associated with blood lactate accumulation in Streptozotocin (STZ) induced diabetic rats. The study aimed to provide a new marker to assist in identifying diabetic individuals at a high risk of developing lactic acidosis. Erythrocyte carbonic anhydrase activity with 4-nitrophenyl acetate as substrates was investigated in (STZ) induced diabetic rats. STZ induced diabetic rats showed significant increase in erythrocyte carbonic anhydrase (CA) activity of 9.7 ± 0.7 μMol/min/μL and blood lactate level of 6.2 ± 1.2 mMol/L when compared with Non Diabetic group CA enzyme activity of 5.5 ± 0.6 μMol/min/μL and blood lactate level of 3.9 ± 0.5 mMol/L. Inhibition of erythrocyte carbonic anhydrase activity with Acetazolamide results in 6.9 fold increase in blood lactate level when compared with Non diabetic group. Therefore inhibition of Carbonic anhydrase in STZ induced diabetic rats' result in blood lactate accumulation and reduced blood glucose concentration.

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