Laparoscopic vs. Open Pyloromyotomy in Treatment of Infantile Hypertrophic Pyloric Stenosis

Abstract

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.

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

“…In contrast to previous reports, Zampieri et al in their study in 60 infants did not find statistically significant difference in regards to outcomes of treatment and complication rates between two operative techniques and concluded that laparoscopic approach is a comparable alternative to the open approach [29]. Similar conclusion was drawn by Shawn et al who reported, among 200 infants, only lesser pain after the procedure and fewer complication rates in the laparoscopic group [30].…”

“…Last two to three decades laparoscopic surgery gained popularity among pediatric surgeons, especially after development of instruments suitable for the pediatric population. 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].…”

“…They also found lesser need of analgesia after surgery and better parents' satisfaction in the laparoscopic group of the infants. They reported two cases of incomplete pyloromyotomy, as well as one wound infection in the laparoscopic group [29].…”

Choice of method of the treatment in newborns with hypertrophic pyloric stenosis

“…[35], протягом багатьох десятиліть залишалась основним методом лікування дітей із ГПС завдяки відмінним результатам і незначній кількості ускладнень [7,20]. У 1991 р. J. L. Alain зі співавторами вперше повідомили про ла-пароскопічну пілороміотомію [2], яка поступово почала широко застосовуватися в щоденній практиці дитячих хірургів [10,22,24].…”

“…Відкрита пілороміотомія залишається основним методом хірургічного втручання і дітей із ГПС, незва- Тривалість лапароскопічної пілороміотомії була довшою порівняно з традиційною, проте ця різниця не є статистично достовірною (р=0,124), що відповідає даним літератури [37,46], хоча в інших дослідженнях тривалість лапароскопічного втручання менша [24,34]. Слід зазначити, що зі збільшенням досвіду тривалість лапароскопічної пілороміотомії скорочується, на чому наголошують й інші дослідники [5].…”