OBJECTIVE: To perform a meta-analysis of studies comparing open pyloromyotomy (OP) and laparoscopic pyloromyotomy (LP) in the treatment of infantile hypertrophic pyloric stenosis. BACKGROUND: LP has become increasingly popular for the management of pyloric stenosis. Despite a decade of experience, the real benefit of LP over the open procedure remains unclear. METHODS: Using a defined search strategy, studies directly comparing OP with LP were identified (n = 8). Data for infants treated by both approaches were extracted and used in our meta-analysis. OP and LP were compared in terms of complications, efficacy, operating time, and recovery time. Weighted mean difference (WMD) between continuous variables and 95% confidence intervals (95% CI) were calculated. For dichotomous data, relative risk (RR) and 95% CI were determined. RESULTS: Only 3 studies were prospective, and just 1 study was a prospective randomized controlled trial. Mucosal perforations and incomplete pyloromyotomy were both more common with LP. Compared with OP, LP is associated with higher complication rate (RR 0.81 [0.5, 1.29], P = 0.4), similar operating time (WMD 1.52 minutes [-0.26, 3.29], P = 0.09), shorter time to full feeds (WMD 8.66 hours [7.25, 10.07], P < 0.00001), and shorter postoperative length of stay (WMD 7.03 hours [3.74, 10.32], P = 0.00003). CONCLUSIONS: OP is associated with fewer complications and higher efficacy. Recovery time appears significantly shorter following LP. A prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.
OBJECTIVE: To perform a meta-analysis of studies comparing open pyloromyotomy (OP) and laparoscopic pyloromyotomy (LP) in the treatment of infantile hypertrophic pyloric stenosis. BACKGROUND:LP has become increasingly popular for the management of pyloric stenosis. Despite a decade of experience, the real benefit of LP over the open procedure remains unclear. METHODS: Using a defined search strategy, studies directly comparing OP with LP were identified (n = 8). Data for infants treated by both approaches were extracted and used in our meta-analysis. OP and LP were compared in terms of complications, efficacy, operating time, and recovery time. Weighted mean difference (WMD) between continuous variables and 95% confidence intervals (95% CI) were calculated. For dichotomous data, relative risk (RR) and 95% CI were determined. RESULTS: Only 3 studies were prospective, and just 1 study was a prospective randomized controlled trial. Mucosal perforations and incomplete pyloromyotomy were both more common with LP. Compared with OP, LP is associated with higher complication rate (RR 0.81 [0.5, 1.29], P = 0.4), similar operating time (WMD 1.52 minutes [-0.26, 3.29], P = 0.09), shorter time to full feeds (WMD 8.66 hours [7.25, 10.07], P < 0.00001), and shorter postoperative length of stay (WMD 7.03 hours [3.74, 10.32], P = 0.00003). CONCLUSIONS: OP is associated with fewer complications and higher efficacy. Recovery time appears significantly shorter following LP. A prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.
Authors: Brendan T Campbell; Kelly McLean; Douglas C Barnhart; Robert A Drongowski; Ronald B Hirschl Journal: J Pediatr Surg Date: 2002-07 Impact factor: 2.545
Authors: Chethan Sathya; Carolyn Wayne; Anna Gotsch; Jennifer Vincent; Katrina J Sullivan; Ahmed Nasr Journal: Pediatr Surg Int Date: 2016-12-10 Impact factor: 1.827
Authors: Shawn D St Peter; George W Holcomb; Casey M Calkins; J Patrick Murphy; Walter S Andrews; Ronald J Sharp; Charles L Snyder; Daniel J Ostlie Journal: Ann Surg Date: 2006-09 Impact factor: 12.969
Authors: Aurélien Binet; C Klipfel; P Meignan; F Bastard; A R Cook; K Braïk; A Le Touze; T Villemagne; M Robert; Q Ballouhey; F Lengelle; S Amar; H Lardy Journal: Pediatr Surg Int Date: 2018-02-06 Impact factor: 1.827
Authors: Ralph F Staerkle; Fabian Lunger; Lukas Fink; Tom Sasse; Martin Lacher; Erik von Elm; Ahmed I Marwan; Stefan Holland-Cunz; Raphael Nicolas Vuille-Dit-Bille Journal: Cochrane Database Syst Rev Date: 2021-03-09