Open Pyloromyotomy Research Articles

Open versus Laparoscopic Pyloromyotomy for Pyloric Stenosis: A Meta-analysis of Randomized Controlled Trials

Aim of the study was to compare the outcomes after laparoscopic pyloromyotomy (LP) with those of open pyloromyotomy (OP) for infantile pyloric stenosis. We conducted searches until February 2009 in multiple databases and identified randomized controlled trials comparing LP with OP for pyloric stenosis. Results were expressed using the odds ratio (OR) for categorical variables and standard weighted mean differences (SMD) for continuous outcomes. Study quality was assessed using the Cochrane Handbook 5.0.1 guidelines and statistical analysis was performed using RevMan 5.0.8 software. 3 studies totaling 492 infants were included. The results showed no significant differences in complications between the groups with regard to wound infection (OR: 1.77, 95% CI 0.58-5.35), mucosal perforations (OR: 0.96, 95% CI: 0.22-4.26), incisional hernia or granuloma (OR: 1.39, 95% CI: 0.41-4.73), incomplete pyloromyotomy (OR: 0.13, 95% CI: 0.02-1.07), substantial vomiting (OR: 0.67, 95% CI: 0.30-1.52) and total complications (OR: 0.91, 95% CI: 0.54-1.53). Although the combined result of 2 studies also indicated an insignificant discrepancy in time-related outcomes for full time to feeds, length of stay after surgery and operating time (SMD: 0.78, 95% CI: -0.50-2.06; SMD: 1.27, 95% CI: -1.56-4.10; SMD: -0.46, 95% CI: -1.11-0.20, respectively), another study indicated shorter times for LP procedures (p=0.002, 0.027, and 0.008, respectively). Only a few trials were available for analysis. Heterogeneity was seen between studies, but the available trials were of high quality. The present study shows that both OP and LP are equally safe and effective procedures for the management of pyloric stenosis in children. However, there was a trend in LP toward shorter time time-related outcomes.

Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant

High volume tubing is used to deliver carbon dioxide during laparoscopic procedures. Failure to prime the tubing with carbon dioxide prior to abdominal insufflation may result in the delivery of nitrogen-containing air to the abdominal cavity. We report a case in which initial insufflation of laparoscopic gas resulted in immediate cardiovascular collapse requiring prolonged resuscitation. Persistent intracranial emboli following the arrest may have resulted from nitrogen contamination of the delivered gas. A 12-day-old female underwent laparoscopy for pyloric stenosis. During initial insufflation of the abdomen, the patient had an abrupt decrease in end-tidal carbon dioxide (CO(2ET)) associated with bradycardia and pulseless electrical activity. Three hours after successful resuscitation and open pyloromyotomy, computerized tomography documented intra-arterial gas within the cerebral and hepatic circulations that resolved following hyperbaric oxygen therapy. Magnetic resonance imaging five days later revealed watershed infarcts in the right frontal and parietal regions. Nitrogen, an insoluble gas not easily eliminated from the body, was likely the gas present within the patient's circulation several hours after the event. It was unlikely carbon dioxide, which is a highly soluble gas that binds to hemoglobin and is rapidly buffered by the carbonic anhydrase system and excreted by the lung. Room air contamination of high volume insufflation tubing allows nitrogen to enter body cavities during endoscopic procedures. Persistence of emboli following endoscopic procedures suggests that the entrained gas is insoluble. Room air contamination increases the potential for catastrophic events during laparoscopy and other endoscopic procedures.

Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial

Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial

The Clinical Features and Management of IHPS: A Comparison between 1980's and 2000's

Purpose: A precise and simple tool for diagnosis and the growing public interest in health caused infantile hypertrophic pyloric stenosis (IHPS) to be diagnosed in good time. The approach to pyloromyotomy as the standard treatment is undergoing changes. We compared 2000’s IHPS patients with 1980’s to identify the clinical features and management. Methods: We analyzed, retrospectively, the clinical findings, diagnoses, and treatment of 68 patients with IHPS who underwent pyloromyotomy at Ewha Womans University Medical Center from January 2000 to December 2008 (2000’s group), and compared the results with that of 42 patients in the 1980’s (1980’s group). Results: There were no significant differences in age, gender, birth rank, seasonal distribution, and symptoms between both groups, but the number of patients with metabolic changes and palpable ‘olive’ was significantly lesser in the 2000’s group. Upper gastrointestinal series (UGI) was the most common imaging tool in the 1980’s (71.4%) but USG has become the standard diagnostic tool in the 2000’s (88.2%). All patients received open pyloromyotomy using traditional incision in the 1980’s, and supraumbilical semicircular incision in 36.8% of patients in the 2000’s. The average length of hospital stay after operation was significantly shorter in the 2000’s group. In the 2000’s, the mean preoperative stay at hospital was 4.4±4.3 days. Twenty-nine (42.0%) patients did not vomit postoperatively and postoperative vomiting did not delay discharges of any patients. Conclusion: There were significant improvements in diagnosis and treatment in the 2000’s. We suggest that the surgeon, without the need for a radiologist perform USG for IHPS in order to shorten the preoperative hospital stay.

Impact of surgical approach on outcome in 622 consecutive pyloromyotomies at a pediatric teaching institution

Purpose The aim of this study is to compare the outcome of 3 different approaches to pyloromyotomy in a large single institution series. Methods Records of consecutive patients undergoing pyloromyotomy for an 8-year period were reviewed. Patients' age, sex, weight, operating time, length of stay, number of emeses, and complications were recorded. Variables were compared between right upper quadrant (RUQ), umbilical (UMB), and laparoscopic (LAP) approaches. Results Six hundred twenty-two patients were included in the study. Operating time was significantly shorter for LAP and RUQ compared to UMB. Length of stay did not differ between the groups. There were fewer episodes of emesis in the LAP group. There was a trend toward a higher rate of complications in UMB group. Conclusion Outcomes after pyloromyotomy are institution dependent and cannot be generalized. Patient safety is the first concern, followed by patient comfort and cosmesis. Laparoscopic pyloromyotomy can be as fast and efficient as open, without an increased rate of complications, with excellent cosmetic results, and less analgesic requirement. If skill and experience to replicate good outcomes of laparoscopy are not available, open pyloromyotomy is a safer technique. The UMB approach is an alternative method to achieve good cosmesis without laparoscopy in the hands of a surgeon proficient in this method.

Impact of spinal anesthesia for open pyloromyotomy on operating room time

Purpose When pyloromyotomy for hypertrophic pyloric stenosis (HPS) is performed under general anesthesia, metabolic abnormalities and fluid deficits coupled with residual anesthetics may increase the risk of postoperative apnea, thereby, prolonging operating room time and delaying extubation. Spinal anesthesia has been found to reduce the rate of postoperative apnea in high-risk infants. The aim of the study was to evaluate the effect of spinal vs general anesthesia on operating room time in infants undergoing open pyloromyotomy. Methods Data for 60 infants who underwent pyloromyotomy under spinal (n = 24) or general (n = 36) anesthesia at a tertiary pediatric medical center were derived from the computerized database. Primary outcome measures were total operating room time, procedure duration, anesthesia release time, wake-up time, and anesthesia control time (anesthesia release plus wake-up). Nonparametric Mann-Whitney test was used for statistical analysis, and Levene's test was used to assess the equality of variances in samples; P ≤ .05 was considered significant. Results Mean total operating room time was 50.9 (12.1) minutes in the spinal anesthesia group and 69.5 (26.8) minutes in the general anesthesia group ( P = .001). Corresponding values for mean wake-up time were 3.6 (2.9) and 17.2 (25.3) minutes ( P < .001), and for mean anesthesia control time, 13.2 (6.7) and 28.5 (24.6) minutes ( P < .001). There were no between-group differences in procedure duration or anesthesia release time. On Levene's test, between-group differences were significant for total operating time and wake-up time ( P = .01 for both). Conclusions The use of spinal anesthesia for open pyloromyotomy in infants with HPS shortens the operating room time by reducing the wake-up time.

Laparoscopic or Open Surgery for Infantile Pyloric Stenosis

Infantile pyloric stenosis can be corrected with either laparoscopic or open pyloromyotomy. To compare the two corrective methods, researchers

Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial

A laparoscopic approach to pyloromyotomy for infantile pyloric stenosis has gained popularity but its effectiveness remains unproven. We aimed to compare outcomes after open or laparoscopic pyloromyotomy for the treatment of pyloric stenosis. We did a multicentre international, double-blind, randomised, controlled trial between June, 2004, and May, 2007, across six tertiary paediatric surgical centres. 180 infants were randomly assigned to open (n=93) or laparoscopic pyloromyotomy (n=87) with minimisation for age, weight, gestational age at birth, bicarbonate at initial presentation, feeding type, preoperative duration of symptoms, and trial centre. Infants with a diagnosis of pyloric stenosis were eligible. Primary outcomes were time to achieve full enteral feed and duration of postoperative recovery. We aimed to recruit 200 infants (100 per group); however, the data monitoring and ethics committee recommended halting the trial before full recruitment because of significant treatment benefit in one group at interim analysis. Participants, parents, and nursing staff were unaware of treatment. Data were analysed on an intention-to-treat basis with regression analysis. The trial is registered with ClinicalTrials.gov, number NCT00144924. Time to achieve full enteral feeding in the open pyloromyotomy group was (median [IQR]) 23.9 h (16.0-41.0) versus 18.5 h (12.3-24.0; p=0.002) in the laparoscopic group; postoperative length of stay was 43.8 h (25.3-55.6) versus 33.6 h (22.9-48.1; p=0.027). Postoperative vomiting, and intra-operative and postoperative complications were similar between the two groups. Both open and laparoscopic pyloromyotomy are safe procedures for the management of pyloric stenosis. However, laparoscopy has advantages over open pyloromyotomy, and we recommend its use in centres with suitable laparoscopic experience.

Practice Makes Perfect: Progressive Improvement of Laparoscopic Pyloromyotomy Results, with Experience

Pyloric stenosis can now be treated effectively with laparoscopic pyloromyotomy (LP). Few large outcome studies have been published regarding the laparoscopic technique. In this paper, we describe our experience with the first 185 consecutive LPs. An institutional review board-approved retrospective outcomes analysis was performed on our first 185 consecutive LPs. Previous publications comparing open pyloromyotomy (OP) and LP are reviewed. Our hypothesis is that, with experience, the outcome of LP will equal or surpass that of OP. A total 185 infants underwent LPs during the study period. The infants had median values of age: 33 days; body weight: 4 kg; surgery duration: 25 minutes; postoperative length of stay (LOS): 25.5 hours; and total LOS: 45 hours. There were 7 complications (3.78%): 4 incomplete pyloromyotomies (2.2%), 1 pyloric mucosal perforation (0.5%), 1 delayed duodenal perforation (0.5%), and 1 wound infection (0.5%). There has been a progressive reduction in the time required for surgery, from a median of 29 minutes in the first 60 cases to 21.5 in the last 65. Postoperative LOS has fallen from a median of 26 hours in the first half to 24.5 in the later half. Complications occurred primarily in the first third of our cases. We are able to demonstrate that, with experience, one can expect progressive improvement in the outcomes following LP in infants. Our surgery duration and complications in the last 65 cases are better than most published results for OP or LP.

Open vs. laparoscopic pyloromyotomy – a retrospective analysis

Laparoscopic pyloromyotomy has obtained increasing importance in the last years. However, there is no proof of an obvious advantage of the laparoscopic over the open approach. This retrospective analysis of 157 infants with pyloromyotomies (129 open and 28 laparoscopic procedures) should settle the benefit of one of these procedures. The duration of the operation in the laparoscopic procedure was significantly shorter than in open pyloromyotomy (median 25 versus 34 min; p = 0.025). Complete oral feeding was reached after similar postoperative time in both groups, but the postoperative hospital length of stay in the laparoscopic group was significantly shorter than in the open group (3.5 versus 7 days, p = 0.008). The postoperative requirements for analgetics were low and showed no difference in both groups. In our clinic the laparoscopic pyloromyotomy was successfully introduced as standard operating procedure. There was no difference in the complication rate as compared to the open procedure. The recovery time was shorter in the laparoscopic group. A superiority of the laparoscopic pyloromyotomy over the open procedure is suggested by the ascertained data.

Ghosts in the machine: a multi-institutional comparison of laparoscopic and open pyloromyotomy

The purpose of this study was to compare laparoscopic and open pyloromyotomy using data from multiple centers in the United States. Children's hospitals that have a predominant surgical approach to pyloromyotomy were identified in the Pediatric Health Information System database. Using 2005 data, institutions were stratified into open (OPEN) and laparoscopic (LAP) groups. Patients with significant comorbid conditions were excluded. Group differences were compared using t tests and Mann-Whitney nonparametric tests for continuous variables and exact tests for categorical variables. A total of 3 hospitals were in the LAP group (n = 207), and 4 hospitals were in the OPEN group (n = 357). The LAP group had a longer mean length of stay (LAP = 2.5 +/- 1.7, OPEN = 2.1 +/- 1.4 days; P = .02). Mean total hospital charges were similar in both groups (LAP = $11307 +/- 9499, OPEN = $11245 +/- 4841; P = .93), but there was significant skewness of the distribution for the LAP group. Nonparametric analysis demonstrated a statistically significant difference in charges (LAP median = $9727, min = $5075, max = $94323, OPEN median = $10001, min = $1614, max = $46461; P = .004). Four patients in the LAP group had charges ranging from approximately $56000 to $94000, which may have resulted from surgical complications. Prolonged length of stay and skewed hospital charge data in patients undergoing laparoscopic pyloromyotomy may be the result of rare but serious complications associated with the laparoscopic approach.

Comparison of Laparoscopic to Open Pyloromyotomy

Comparison of Laparoscopic to Open Pyloromyotomy

P177: Training general surgery residents in pediatric surgery: Analysis of time and cost

Background: Resident participation in the pediatric surgery service is essential to their training. The impact with regard to operative time and hospital cost is not well-defined. Hypothesis: Training general surgery residents in pediatric surgery significantly increases operative time and hospital cost. Methods: A retrospective analysis of operative times was performed for three common pediatric operations: unilateral inguinal herniorraphy, bilateral inguinal herniorraphy, and open pyloromyotomy. All cases occured between July 2004 and July 2006. In Group 1 all operations were performed by a single attending pediatric surgeon. Group 2 involved the same attending surgeon directing a 3rd -year general surgery resident through the operations. Operative time was defined as the time from skin incision to placement of the final dressing. Surgery schedules and a cost analysis were also analyzed for the 2 groups. Statistical analysis was performed using student t-test. Results: Demographics between the two groups were similar. Mean operative time was shorter in Group 1 with respect to unilateral and bilateral herniorraphy. Mean operative time for pyloromyotomy was similar between the 2 groups. No perioperative complications or recurrent hernias occured in either group. Surgery schedules (number of operations per day) were similar between the 2 groups. Furthermore, decreased time in performing herniorraphy without surgery residents would not lead to more operative cases performed per day, thus hospital cost and surgeon fees are similar between the 2 groups. Conclusion: Training general surgery residents in pediatric surgery increased operative time with respect to unilateral and bilateral herniorraphy. There was no increase in operative with respect to pyloromyotomy. Increased operative time to train general surgery residents did not influence surgical scheduling, thus there was no increase in cost to the hospital or surgeon. Tabled 1Operative time (minutes) between the 2 groups Group 1 Group 2 p Unilateral herniorraphy 31.2 ± 10.4 (n=41) 40.1 ± 15.2 (n=35) 0.003 Bilateral herniorraphy 44.9 ± 13.4 (n=30) 54.0 ± 16.6 (n=20) 0.04 Pyloromyotomy 32.9 ± 9.6 (n=10) 34.6 ± 7.4 (n=15) 0.61 Open table in a new tab

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

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.

Minimal Access Surgery in the Neonate

After completing this article, readers should be able to: 1. Review physiologic, anatomic, and technical issues related to minimal access surgery in the neonate. 2. Describe conditions in which minimal access surgery can be used in neonates. Historically, pediatric surgeons were slow to adapt to minimal access surgery (MAS) techniques compared with the adult surgical community. However, MAS now is widely established in infants and children. Differences in size and physiology have necessitated a number of surgical and technological modifications to apply MAS techniques to this population. This review outlines the important differences between children and adults with respect to MAS and provides examples of the use of MAS for diseases seen in infants. ### Physiologic Issues The physiologic response to pneumoperitoneum in children is more pronounced than in adults. Peritoneal insufflation with carbon dioxide has been shown to cause hypercarbia, acidemia, and decreased oxygenation in the pediatric piglet model. (1) In infants, however, there is no detrimental effect on blood pressure, heart rate, or oxygen saturation during short periods of pneumoperitoneum, and elevations in end-tidal CO2 can be counteracted readily by increasing the minute ventilation. (2) Hypercarbia-induced pneumoperitoneum in infants is associated with changes in cerebral blood flow and cardiac output. Nevertheless, laparoscopic procedures have been performed safely with proper anesthetic management in children who have even severe congenital cardiac abnormalities such as hypoplastic left heart syndrome. (3) Hypothermia also can be a concern due to rapid insufflation of unwarmed CO2 gas, mandating the moderation of flow rates. (4) ### Anatomic Issues A number of anatomic factors set children apart from adults and must be accounted for when performing laparoscopic surgery in this age group. Young children and infants have thinner abdominal walls than adults, so extreme care must be exercised when placing trocars. Due to the small size of the abdomen, the working …

An effective pyloromyotomy length in infants undergoing laparoscopic pyloromyotomy

Traditional management of pyloric stenosis has consisted of open pyloromyotomy during which the surgeon is able to palpate and determine whether the hypertrophied pylorus has been completely divided. During the last decade, laparoscopic pyloromyotomy has become an increasingly popular approach for this condition. The purpose of this study was to determine whether there is an effective pyloromyotomy length that will allow the surgeon to feel confident that a complete pyloromyotomy was performed with the laparoscopic approach. All infants undergoing laparoscopic pyloromyotomy from October 1999 through October 2003 at a single institution were retrospectively studied. Clinical variables collected included the patient's age, gender, electrolyte status on admission, the elapsed time from admission to operation, ultrasonographic dimensions of the hypertrophied pylorus, operative time, the length of the pyloromyotomy performed, the time to initial and to full feedings, and the duration of the postoperative hospitalization. One hundred seventy-one patients comprised the study group. The age (mean +/- standard deviation) at the time of operation was 5.2 +/- 2.8 weeks. The mean preoperative ultrasonic measurements for both pyloric thickness and pyloric length were 4.3 +/- 0.7 mm and 19.5 +/- 2.8 mm, respectively. The average pyloromyotomy incision length for this entire group was 1.9 +/- 0.21 cm. The mean operative time was 23.5 +/- 8.3 minutes. There were no mucosal perforations, no conversions to an open procedure, and no evidence for an incomplete pyloromyotomy. Laparoscopic pyloromyotomy is a safe and effective technique for infants with pyloric stenosis. A pyloromyotomy incision length of approximately 2 cm appears to be an effective measure of a complete pyloromyotomy.

Laparoscopic Pyloromyotomy: Experience Based on 14 Cases

Infantile hypertrophic pyloric stenosis is a common problem in pediatric surgery. Conventional management by the open extramucosal pyloromyotomy has been the method of choice for decades. Advanced, minimally invasive surgery also allows successful endoscopic management of this entity. We report our experience with 14 cases of laparoscopic pyloromyotomy, concentrating on technical details. The infants tolerated the operative procedure well. There was one complication, a perforation that was spotted immediately and managed with conversion to the open method with sutures. Our experience suggests that laparoscopic pyloromyotomy can be a safe and efficient procedure, but during the learning phase, the indication for laparoscopy should be decided on a case-by-case basis and performed by an experienced laparoscopic surgeon. Careful selection of patients is helpful to increase confidence and operative comfort.

Ad libitum feeding: Safely improving the cost-effectiveness of pyloromyotomy

Background/Purpose: Patients undergoing pyloromyotomy traditionally have been placed on complex postoperative feeding regimens. The authors evaluated the substitution of an ad libitum feeding regimen to determine if it could decrease length of hospital stay and cost without increasing the moribidity rate. Methods: Fifty-six consecutive patients undergoing open pyloromyotomy were evaluated. The initial 31 patients were treated with a traditional protocol, whereas the next 25 patients received ad libitum feeding. Time to first full-strength feeding, amount and time of any emesis, and time to discharge were recorded. Hospital costs and number of readmissions were assessed. Results: Patients in the ad libitum group had a statistically significant shorter time to discharge (25.1 hours versus 38.8 hours), which translated into a savings of $1,290 per patient. Whereas more patients in the ad libitum group experienced postoperative emesis (32% v 26%), this was not statistically significant. There was no other morbidity and there were no readmissions in either group. Conclusions: Postoperative ad libitum feedings resulted in significant decreases in hospital stay and associated costs without increasing morbidity. Ad libitum feeding is safe, simple, and cost effective, and may offer an avenue for short-stay pyloromyotomy in selected patients. J Pediatr Surg 37:1667-1668. Copyright 2002, Elsevier Science (USA). All rights reserved.

Comparison between laparoscopic pyloromyotomy and open pyloromyotomy for infants with congenital hypertrophic pyloric stenosis

OBJECTIVE: To compare the efficacy of laparoscopic pyloromyotomy with open pyloromyotomy in treatment of congenital hypertrophic pyloric stenosis(CHPS). METHODS: Fifteen patients (age 20%ape;90 days, body weight 2.5 approximate, equals 5.0 kg) with CHPS underwent laparoscopic pyloromyotomy (Group I) and 10 patients (age 26 approximate, equals 90 days, body weight 2.8 approximate, equals 4.5 kg) with CHPS underwent open pyloromyotomy (Group II). Ambulatory 24 hr esophageal pH metry and gastroesophageal mamometry were studied in two groups before and after surgery. RESULTS: All patients presented gastroesophageal reflux (GER) before operation and all reflux parameters were significantly decreased after operation (P<0.01). There was no significant difference between two groups in reflux parameters after surgery. Intragastric pressure (GP) significantly reduced in two groups after operation(3.83+/-1.45)mmHg compared with (2.38+/-0.54)mmHg P<0.01 in Group I,(4.52+/-1.96)mmHg compared with (2.38+/-0.72)mmHg P<0.05 in Guoup II). There was no significant difference in lower esophageal sphincter pressure (LESP), lower esophageal sphincter length (LESL) before and after operation in two groups. The mean operative time for Group I was (32+/-19) mins, which was close to that of Group II after an initial trail. Oral feeding was started 6 h postoperatively in Group I, which was earlier than that in Group II. No technical failures and complications in Group I were encountered. One wound infection and dehiscense was seen in Group II. CLUSION: Laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis is safe and feasible, which has lesser complication and similar effect of antireflux as open pyloromyotomy.

A comparison of laparoscopic and open pyloromyotomy at a teaching hospital

Background/Purpose: An increasing number of pediatric surgeons are using the laparoscopic approach to treat pyloric stenosis. The advantage of laparoscopic pyloromyotomy is uncertain and has not been evaluated in the setting of a pediatric surgery fellowship program. Methods: The authors retrospectively reviewed the medical records of all patients who underwent pyloromyotomy for congenital hypertrophic pyloric stenosis at their institution from January 1, 1997 through December 31, 2000 (n = 117). Information obtained included age, sex, weight, admission laboratory values, attending surgeon, resident surgeon and their level of training, operating time, intraoperative and postoperative complications, time to full feedings, incidence of postoperative emesis, duration of postoperative emesis, length of stay, and total hospital charges. These variables then were compared between the open (OPEN) and laparoscopic (LAP) groups. Results: From January 1, 1997 through December 31, 2000, 65 LAP and 52 OPEN pyloromyotomies were performed. Characteristics of patients in the OPEN and LAP groups were similar. The mean operating time was 33 ± 2 minutes for OPEN versus 38 ± 2 minutes for LAP (P =.07). The incidence of postoperative emesis (LAP, 68%, OPEN, 65%), duration of postoperative emesis (LAP, 7.3 ± 1.2 hours; OPEN, 8.1 ± 1.8 hours), and time to full feedings (LAP, 19.5 ± 1.6 hours; OPEN, 19.5 ± 1.3 hours) did not differ significantly between groups (P >.05). Mean postoperative length of stay in both groups was similar (LAP, 31 ± 5; OPEN, 28 ± 2 hours; P =.64). Mucosal perforation occurred in 5 patients (8%) in the Lap and 2 patients (4%) in the OPEN group (P =.39). Postoperative complications occurred in 12 LAP (18%) and 6 OPEN patients (12%, P =.31). Five LAP cases were converted to OPEN. In the LAP group there was one unrecognized mucosal perforation and one incomplete pyloromyotomy both of which required reoperation. As the laparoscopic approach was adopted, general surgery resident participation as operating surgeon in these cases decreased from 81% in 1997 to 19% in 2000. Hospital charges were higher in the LAP group, but not significantly (LAP, $6,676 ± 1,005; OPEN, $5,292 ± 306; P = 27). Conclusions: Laparoscopic pyloromyotomy has progressively become the dominant surgical approach to pyloromyotomy at our institution. The LAP and OPEN approaches have similar outcomes. However, the Lap approach may be associated with increased complication rates, a reduction in general surgery resident operative experience, and higher hospital charges. J Pediatr Surg 37:1068-1071. Copyright 2002, Elsevier Science (USA). All rights reserved.