Laparoscopic extramucosal pyloromyotomy versus open pyloromyotomy for infantile hypertrophic pyloric stenosis: Which is better?

Background/Purpose: The aim of this study was to evaluate the advantages or disadvantages of laparoscopic pyloromyotomy compared with open transumbili cal fold pyloromyotomy. Methods: Thirty consecutive laparoscopic extra mucosal pyloromyotomies (LP) performed from 1994 to 1997 were compared with 30 consecutive open pylorom yotomies (OP) performed during the same period with regard to age at operat ion, body weight, thickness of hypertrophied pyloric muscle, operating time , time of return to full feeding, frequency of postoperative emesis, surgic al complications, and degree of surgical stress reflected by interleukin-g (IL-6). LP was performed according to conventional techniques, and OP was p erformed using a transumbilical fold approach. Results: The groups were matched for age at operation, preoperative clinica l and physical status, laboratory data, and size of the hypertrophied pylor us assessed by ultrasonography. There was a learning curve with LP; the ave rage operating time required for the first 10 cases was significantly longe r than the time required for OP, but later cases took just as long as OP ca ses. Time taken to full feeding was significantly shorter in the LP group t han the OP group (LP, 38 hours v OP, 64 hours). One case was converted from LP to OP because of mucosal perforation. The incidence of postoperative em esis was significantly higher in the OP group than in the LP group (OP, 25% v LP, 3%). The mean length of hospitalization was significantly shorter in LP (P < .01). The intraoperative peak values of IL-6 in LP were significan tly lower than those in the OP group (P < .01). Conclusions: The advantages of LP are improved cosmesis, decreased surgical stress with earlier postoperative recovery, and shorter hospitalization. B ecause LP uses reusable devices, and the mean period of hospitalization is shorter, average operating costs could be reduced, representing a net savin g in total hospital charges. J Pediatr Surg 34:370-372. Copyright (C) 1999 by W.B. Saunders Company.