Completed Prospective Studies Laparoscopic vs. Open Pyloromyotomy for Pyloric Stenosis

Laparoscopic vs. 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 Surgery 2006;244(3):363-70.)

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 open group.

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.

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