Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis—A Systematic Review and Meta-Analysis

Abstract

Introduction: Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the open versus laparoscopic technique. Methods: A literature search was conducted from 1990 to February 2021 using the electronic databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Primary outcomes were mucosal perforation and incomplete pyloromyotomy.Secondary outcomes consisted of length of hospital stay, time to full feeds, operating time, postoperative wound infection/abscess, incisional hernia, hematoma/seroma formation, and death.Results: Seven randomized controlled trials including 720 patients (357 with OP and 363 with LP) were included. Mucosal perforation rate was not different between groups (relative risk [RR] LP versus OP 1. 60 [0.49-5.26]). LP was associated with nonsignificant higher risk of incomplete pyloromyotomy ). There was no difference in neither postoperative wound infections after LP compared with OP (RR 0.59 [0.24-1.45]) nor in postoperative seroma/hematoma formation ) or occurrence of incisional hernias ). Length of hospital stay (À3.01 h for LP [À8.39 to 2.37 h]) and time to full feeds (À5.86 h for LP [À15.95 to 4.24 h]) were nonsignificantly shorter after LP. Operation time was almost identical between groups (þ0.53 min for LP [À3.53 to min]).Conclusions: On a meta-level, there is no precise effect estimate indicating that LP carries a higher risk for mucosal perforation or incomplete pyloromyotomies compared with the open equivalent. Because of very low certainty of evidence, we do not know about the effect of the laparoscopic approach on postoperative wound infections, postoperative

Transumbilical single-site two incision laparoscopic pyloromyotomy for pediatric hypertrophic pyloric stenosis

“…In the present study, no severe postoperative complications were documented in either of the approaches. The overall postoperative complication rate of LP in our cohort was 7.8%, which was comparable to that in previous studies [ 8 , 21 , 23 ]. When comparing the rate of the most common postoperative complication, our results are equivalent to others, with a rate of 4.7% for wound infection in our cases.…”

“…In the literature, wound infection, fascial dehiscence and omental herniation are frequently reported postoperative complications. Previous studies found that there were no significant differences in the postoperative complication rate between open and laparoscopic pyloromyotomy [ 18 , 21 ]. In the present study, no severe postoperative complications were documented in either of the approaches.…”

“…Common perioperative complications after pyloromyotomy include incomplete pyloromyotomy and mucosal perforation [ 8 , 21 – 23 ]. In the present study, satisfactory TUSSLP results were achieved in our patients.…”

Nationwide trends of laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis in Germany: A slow path forward

“…As shown, pyloromyotomy is a procedure with a low rate of complications and mortality for either technique. Until now, there is no clear advantage of the minimal invasive surgery, but also no clear disadvantage ( 16 , 34 ). Open pyloromyotomy can be considered the conventional standard procedure, which is usually performed by residents or even by general surgeons.…”