Hypertrophic Pyloric Stenosis: 10 Years' Experience with Standard Open and Laparoscopic Approach

Abstract

Purpose Hypertrophic pyloric stenosis (HPS) is the most common cause of gastric obstruction in newborns. Extra-mucosal pyloromyotomy can be performed through a small laparotomy or laparoscopy. The aim of this study was to compare the two surgical techniques. We also analyzed the incidence of HPS in infants in the last 10 years in relation to the demographic trend of our province. Methods We analyzed all the cases of HPS treated at our Unit between January 2010 and December 2019. The data were obtained from operating systems. Data about the demographic trends, in particular, the number of births and the population residing in the province of Verona from 2010 to 2019, were also retrieved. Results During the study period, 60 patients were treated for HPS and met the inclusion criteria. Of these, 56 males and 4 females with an average age of 38±14 days at surgery were included. No differences were found in terms of the duration of surgery, post-operative complications, duration of hospitalization, and weight at the time of surgery. The only statistically significant data was the chlorine level in cases with and without post-operative vomiting (97±3.5 vs. 102±3.3 mmol/L, p <0.05). There was a lower incidence of HPS from 2014 to 2019; however, there was no significant evidence regarding the correlation between this and the reduced birth rate recorded in the province of Verona during the same period. Conclusion Although laparoscopic pyloromyotomy is a highly complex procedure, it is a feasible alternative to the classic open technique.

The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants

“…Various pediatric procedures such as hernia repair, varicocelectomy, cholecystectomy, appendectomy, pyloromyotomy etc., which until then had been performed exclusively by the open approach, began to be performed using laparoscopic approach [15][16][17][18][19][20][21][25][26][27][28][29]. Numerous studies reported benefits of laparoscopic approach for treatment of hypertrophic pyloric stenosis such as faster recovery, faster postoperative feeding, lesser pain, shorter surgical and hospitalization times and lower incidence of wound related complications [6,11,[15][16][17][18][19][20][21][22]. The cosmetic results are incomparably better in infants operated using laparoscopic approach [6,11,[15][16][17][18][19][20][21][22].…”

“…Recently, with breakthrough of laparoscopic surgery among the pediatric surgeons laparoscopic pyloromyotomy has been more frequently used due to its benefits, such as significantly lesser duration of surgery, faster oral intake, faster recovery, lesser pain and tissue trauma, and excellent cosmetic effects [6,11,[15][16][17][18]. In regards to efficacy of the procedure a meta-analysis confirmed that laparoscopic approach had the same safety and efficacy as open surgery [15].…”

“…In the beginning, infants occasionally vomit after the meal. However, as the disease progresses the infants present with typical clinical appearance of hypertrophic pyloric stenosis, projectile vomiting after every meal, which if left untreated may potentially lead to dehydration, electrolyte imbalance, and weight loss [1][2][3][4]6]. In a certain percentage of infants, a hard, non-tender pylorus (so-called olive) may be palpated near the epigastrium.…”

“…The success rates of conservative treatment with atropinesulfate varies between 68 and 87% [11][12][13][14]. The surgical approach involves pyloromyotomy, which can be performed in the traditional open way or, more recently, by laparoscopic approach [6,11]. The traditional open technique is well-known with adequate postoperative effects but recovery after surgery lasts a little longer due to slower oral intake and a higher level of pain due to abdominal incision, cosmetic effects are poor as well [6,11,15].…”

“…In the majority of the centers traditional laparoscopic pyloromyotomy is performed using a retractable pyloromyotomy knife for incision of the hypertrophied pylorus [5,6,[15][16][17][18]. However, in all centers, especially in countries with lower socio-economic status, such an instrument is not always available, so pediatric surgeons used various modifications of this knife to perform the procedure by laparoscopic approach.…”