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

Ibrahim Ismail,Radi Elsherbini,Hesham Sheir,Kamal Aly,Adham Elsaied

doi:10.3389/fped.2020.00426

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.

Highlights

Infantile hypertrophic pyloric stenosis (IHPS) is a common disease in infants and occurs in about 2–4 per 1,000 live births [1]
Laparoscopic pyloromyotomy was expected to add the advantages of the minimal invasive surgery resulting in faster recovery, shorter hospital stay, and better cosmetic outcome when compared with open pyloromyotomy (OP) [4, 5]
The probability of error at 0.05 was considered significant. Both groups of laparoscopic and OP were matched regarding the age at onset, age at time of operation, sex, body weight, sonographic dimensions of the pyloric muscle, and the time needed to correct dehydration, with no statistically significant difference that may affect the comparative study

Summary

Introduction

Infantile hypertrophic pyloric stenosis (IHPS) is a common disease in infants and occurs in about 2–4 per 1,000 live births [1]. Surgical pyloromyotomy is the standard treatment for IHPS and was classically approached via an open upper quadrant or supraumbilical incision [2]. Laparoscopic pyloromyotomy was expected to add the advantages of the minimal invasive surgery resulting in faster recovery, shorter hospital stay, and better cosmetic outcome when compared with open pyloromyotomy (OP) [4, 5]. It was unclear whether the use of laparoscopy may lead to a higher complications rate and exposure to possible side effects of carbon dioxide insufflation in infants [6, 7]. Owing to the conflicting results from randomized controlled trials, there is no clear consensus among authors and pediatric surgeons on which approach carries better results and lower incidence of complications over the other [8,9,10]

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