Open Pyloromyotomy for Pyloric Stenosis (St. Peter, S.D., Holcomb,
G.W., Calkins C.M., Murphy J.P., Andrews, W.S., Sharp R.J., Snyder,
C.L., Ostlie D.J., Open versus Laparoscopic Pyloromyotomy for
Pyloric Stenosis: A Prospective, Randomized Trial. Presented at the
2006 meeting of the American Surgical Association. Annals of
This was a prospective randomized study involving infants less
than three months of age with pyloric stenosis.
Subjects with ultrasound-proven pyloric stenosis were randomized
to either open or laparoscopic pyloromyotomy. Postoperative pain
management, feeding schedule and discharge criteria were identical
for both groups. Operating time; postoperative emesis; analgesia
requirements; time to full feeding; length of hospitalization after
operation; and complications were compared.
From April 2003 through March 2006, 200 infants were enrolled in
the study. There were no significant differences in operating
time, time to full feeding or length of postoperative
hospitalization. There were significantly fewer number of emesis
episodes and doses of analgesia given in the laparoscopic group.
One mucosal perforation and one incisional hernia occurred in the
Late in the study, one patient in the laparoscopic group was
converted to the open operation. A wound infection occurred
in four of the open patients compared to two of the
laparoscopic patients (P = 0.68).
Conclusion: There is no difference in operating
time or length of recovery between open and laparoscopic
pyloromyotomy. However, the laparoscopic approach results in less
postoperative pain and reduced postoperative emesis. In addition,
there were fewer complications in the laparoscopic group. Finally,
patients approached laparoscopically will likely display superior
cosmetic outcomes with long-term follow-up.