Pyloric stenosis, the most common surgical condition of infants, is treated by longitudinal myotomy of the pylorus.
Comparative studies to date between open and laparoscopic pyloromyotomy have been retrospective and report conflicting results.
Dr Shawn St. Peter and colleagues compared the 2 techniques.
The investigative team conducted the first large prospective, randomized trial between the 2 approaches.
Subjects with ultrasound-proven pyloric stenosis were randomized to either open or laparoscopic pyloromyotomy.
The investigators noted that postoperative pain management, feeding schedule, and discharge criteria were identical for both groups.
| Laparoscopic approach results in less postoperative pain|
|Annals of Surgery|
Operating time, postoperative emesis, analgesia requirements, time to full feeding, length of hospitalization after operation, and complications were compared.
From 2003 through 2006, 200 patients were enrolled in the study.
The team found no significant differences in operating time, time to full feeding, or length of stay.
There were significantly fewer number of emesis episodes and doses of analgesia given in the laparoscopic group.
The investigators noted that 1 mucosal perforation and 1 incisional hernia occurred in the open group.
Late in the study, 1 patient in the laparoscopic group was converted to the open operation.
The investigators observed that a wound infection occurred in 4 of the open patients compared with 2 of the laparoscopic patients.
Dr St. Peter's team concludes, “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 was a fewer number of complications in the laparoscopic group.”
“Finally, patients approached laparoscopically will likely display superior cosmetic outcomes with long-term follow-up.”