Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis

Sathya, Chethan; Wayne, Carolyn; Gotsch, Anna; Vincent, Jennifer; Sullivan, Katrina; Nasr, Ahmed

doi:10.1007/s00383-016-4030-y

Cited by 33 publications

(25 citation statements)

References 24 publications

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“…It is also worth noting these are the last 2 years prior to the introduction of LP at our centres, but the significance of this is unclear. As previously demonstrated, 17 LPs provide a reduced time to full feeds and discharge, and part of this effect may be reflected in our data subsequent to these years. On the other hand, more objective outcome measures, including biochemical and ultrasound findings, add validity to our study and are more reliable when examining overall trends.…”

Section: Discussionsupporting

confidence: 74%

Presentation and outcomes in hypertrophic pyloric stenosis: An 11‐year review

Vinycomb

Laslett

Gwini

et al. 2019

J Paediatrics Child Health

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Aim: To evaluate the trend in presentation and postoperative outcomes of infants with hypertrophic pyloric stenosis (HPS) over the last decade. Methods: This was a multicentre retrospective study in two tertiary paediatric centres between 2005 and 2015 inclusive. Participants included 626 infants who underwent a pyloromyotomy for HPS. We collected data on presentation features (age, weight, clinical signs, blood gas results, ultrasound findings) and postoperative outcomes (length of stay (LOS), complications, time to first postoperative feed). Results: No trend was identified during the study period with regards to age, weight, biochemical findings (pH, chloride, base excess) or preoperative ultrasound measurements. There was a downtrend in the number of palpated tumours over time, with a mean of 36% of tumours clinically palpated. Pyloric wall thickness had a moderate association with LOS in patients admitted for >8 days (correlation = 0.4752) but had a weak negative association with shorter lengths of stay (≤8 day, correlation = −0.094). Overall, median time to first feed was 7.80 h and improved yearly during the study period (hazard ratio = 1.07). Conclusions: Patients presenting with HPS are not being identified at an earlier age or with fewer biochemical derangements, in contrast to our initial perceptions. Subsequently, biochemical derangements can still play an important role in the diagnosis of HPS, and attention needs to be given to fluid management and electrolyte correction in all patients with HPS.

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Section: Discussionsupporting

confidence: 74%

Presentation and outcomes in hypertrophic pyloric stenosis: An 11‐year review

Vinycomb

Laslett

Gwini

et al. 2019

J Paediatrics Child Health

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“…Several meta-analyses and large retrospective analyses have evaluated comparative outcomes of each approach with varying conclusions [5–8]. Generally, these analyses conclude that open versus laparoscopic approaches have similar safety and effectiveness profiles.…”

mentioning

confidence: 99%

Trends and surgical outcomes of laparoscopic versus open pyloromyotomy

et al. 2018

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“…Two systematic reviews and meta-analyses noted no differences between peri-and postoperative complications. Both studies did not specifically mention serosal tears of the stomach, fascial dehiscence and OH, but analyzed different combinations of major (perioperative) complications or all complications together 3,4 . www.nature.com/scientificreports www.nature.com/scientificreports/ To classify the severity of the complications of pyloromyotomy we used the Clavien-Dindo classification 21 .…”

Section: Discussionmentioning

confidence: 99%

“…Complication rates vary between 4.6-12% 1,2 . There are no differences in operative and postoperative complication rates between laparoscopic and open pyloromyotomy [3][4][5][6] . The most frequently reported complications are incomplete pyloromyotomy, mucosal perforation and wound infection 1,2,[7][8][9][10] .…”

mentioning

confidence: 93%

Comparison of laparoscopic and open pyloromyotomy: Concerns for omental herniation at port sites after the laparoscopic approach

Bunder

Heurn

Derikx

2020

Sci Rep

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comparison of laparoscopic and open pyloromyotomy: concerns for omental herniation at port sites after the laparoscopic approach fenne A. i. M. van den Bunder * , ernest van Heurn & Joep p. M. Derikx pyloromyotomy is a common surgical procedure in infants with hypertrophic pyloric stenosis and can be performed with a small laparotomy or laparoscopically. No specific complications have been documented about one of the approaches. We aim to study (severity of) complications of pyloromyotomy and to compare complications of both approaches. children undergoing pyloromyotomy between 2007 and 2017 were analyzed retrospectively. Complication severity was classified using the Clavien-Dindo classification. We included 474 infants (236 open; 238 laparoscopic). 401 were male (85%) and median (IQR) age was 33 (19) days. There were 83 surgical complications in 71 patients (15.0%). In the open group 45 infants (19.1%) experienced a complication vs. 26 infants in the laparoscopic group (10.5%)(p = 0.013). Severity and quantity of postoperative complications were comparable between both groups. Serosal tears of the stomach (n = 19) and fascial dehiscence (n = 8) occurred only after open pyloromyotomy. Herniation of omentum through a port site occurred only after laparoscopy (n = 6) and required re-intervention in all cases. In conclusion, the surgical complication rate of pyloromyotomy was 15.0%. Serosal tear of the stomach and fascial dehiscence are only present after open pyloromyotomy and omental herniation after laparoscopy respectively. the latter complication is underestimated and requires attention.

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Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis

Abstract: There is no strong evidence to support a recommendation of one procedure over the other; therefore, the choice of laparoscopic or open procedure should be left to the discretion of the surgeon.

Cited by 33 publications

References 24 publications

Presentation and outcomes in hypertrophic pyloric stenosis: An 11‐year review

Presentation and outcomes in hypertrophic pyloric stenosis: An 11‐year review

Trends and surgical outcomes of laparoscopic versus open pyloromyotomy

Comparison of laparoscopic and open pyloromyotomy: Concerns for omental herniation at port sites after the laparoscopic approach

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