A Prospective, Randomized Evaluation of Laparoscopic Versus Open Pyloromyotomy in the Treatment of Infantile Hypertrophic Pyloric Stenosis

Abstract

The advantages of laparoscopic surgery include minimal abdominal wall complications, excellent wound cosmesis, reduced pain, and reduced physiologic insult. We hypothesized that laparoscopic pyloromyotomy will extend these advantages to the treatment of hypertrophic pyloric stenosis in infants while retaining the excellent results attained by the open technique. To test this hypothesis, we assigned 20 infants prospectively and randomly to receive either laparoscopic (n = 10) or open umbilical fold pyloromyotomy (n = 10). The two groups were similar in age, weight, and physiologic state. Laparoscopic pyloromyotomy required less operative time than the open method (19 vs. 24 min). This difference was statistically significant (nonpaired sign rank test, p = 0.01). One patient in the open group suffered a gastric serosal laceration. There were no intraoperative complications in the laparoscopically treated group and no case required conversion to the open method. The mean time to return to full feedings postoperatively was statistically less (nonpaired sign rank test, p = 0.009) for the laparoscopic group (4.4 h) as compared to the open group (8.9 h). No post-operative complications occurred. The common occurrence of hypertrophic pyloric stenosis provides an excellent opportunity to enhance laparoscopic surgical skills in infants. The advantages of the laparoscopic technique include excellent cosmesis, decreased morbidity, and decreased postoperative ileus. We recommend the use of laparoscopic pyloromyotomy in the treatment of this childhood malady.