Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis

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Abstract

Purpose: The aim of the study was to determine whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the most effective intervention in infants with hypertrophic pyloric stenosis. Methods: A systematic review of the published literature was undertaken in February 2009. Prospective studies comparing LP and OP were selected. Age, weight, complications, duration of operation, time to full feedings, postoperative vomiting, and postoperative length of stay (LOS) data were extracted. Results: Six prospective studies (5 level I, 1 level II) with 625 (303 LP, 322 OP) participants met selection criteria. Combined estimates indicated that LP had a lower total complication rate (odds ratio [OR], 0.58 [0.35, 0.97]; P = .04), mostly due to a lower wound complication rate (OR, 0.42 for LP [0.20, 0.91]; P = .03). Patients who underwent LP also had shorter time to full feedings (mean difference [MD], -11.52 hours [-12.77, -10.27]; P < .00001) and shorter postoperative LOS (MD, -5.71 hours [-8.90, -2.52]; P = .0005). No statistically significant differences were noted in the rates of mucosal perforation, wound infection, postoperative emesis, or operating time. Incomplete pyloromyotomy occurred in 6 patients who underwent LP (OR, 7.74 [0.94, 63.38]; P = .06). Conclusions: This meta-analysis favors the laparoscopic approach with significantly reduced rate of total complications, which is mostly due to a lower wound complication rate.

Original languageEnglish
Pages (from-to)1631-1637
Number of pages7
JournalJournal of Pediatric Surgery
Volume44
Issue number8
DOIs
StatePublished - Aug 1 2009

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Meta-Analysis
Postoperative Nausea and Vomiting
Odds Ratio
Length of Stay
Hypertrophic Pyloric Stenosis
Prospective Studies
Wounds and Injuries
Wound Infection
Patient Selection
Weights and Measures

Keywords

  • Hypertrophic pyloric stenosis
  • Laparoscopic pyloromyotomy
  • Meta-analysis
  • Neonatal surgery
  • Open pyloromyotomy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Laparoscopic vs open pyloromyotomy : a systematic review and meta-analysis. / Sola, Juan E; Neville, Holly.

In: Journal of Pediatric Surgery, Vol. 44, No. 8, 01.08.2009, p. 1631-1637.

Research output: Contribution to journalArticle

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