Comparison of outcomes after laparoscopic and open pyloromyotomy at a high-volume pediatric teaching hospital

Abstract

Background/Purpose Laparoscopic pyloromyotomy (LP) is used widely for treatment of hypertrophic pyloric stenosis. We examined the results of pyloromyotomy at a high-volume pediatric teaching hospital to compare outcomes of laparoscopic and open pyloromyotomy (OP). Methods We reviewed the records of all patients who underwent pyloromyotomy at our institution over a 5-year period. Data were collected regarding operative time, time to full feeds, length of hospital stay, complications, and frequency of postoperative emesis. Results There were 335 pyloromyotomies: 212 laparoscopic and 123 open. Five patients in the laparoscopic group required conversion to an open procedure. There were no significant differences in operative time (LP, 30.5 minutes; OP, 32.0 minutes), time to full feeds (LP, 22.4 hours; OP, 23.5 hours), frequency of postoperative emesis (LP, 1.8; OP, 2.2), or length of hospital stay (LP, 49.3 hours; OP, 50.5 hours). There were 5 mucosal perforations in the laparoscopic group and 2 in the open group (LP, 2.3%; OP, 1.6%). There were 3 incomplete pyloromyotomies in the laparoscopic group and none in the open group. Four perforations and all incomplete myotomies occurred in the first 2 years after the laparoscopic technique was introduced at our institution. The overall complication rate was similar (LP, 3.7%; OP, 3.2%). Conclusions Laparoscopic pyloromyotomy is a safe and effective alternative to OP. There appears to be an institutional learning curve when the laparoscopic technique is introduced as reflected by slightly higher rates of mucosal injury and incomplete pyloromyotomy.