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Meta-Analysis
. 2012 Aug;26(8):2104-10.
doi: 10.1007/s00464-012-2174-y. Epub 2012 Feb 21.

Open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a systematic review and meta-analysis focusing on major complications

M W N Oomen  1 , L T Hoekstra, R Bakx, D T Ubbink, H A Heij
Affiliations
Meta-Analysis

Open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a systematic review and meta-analysis focusing on major complications

M W N Oomen et al. Surg Endosc. 2012 Aug.

Abstract

Background: There is an ongoing debate about whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the best option for treating hypertrophic pyloric stenosis (HPS). The aim of this study was to compare the results of both surgical strategies by means of a systematic review and meta-analysis of the available literature.

Methods: A systematic search for randomized clinical trials (RCTs) comparing OP and LP was conducted. Studies were reviewed independently for quality, inclusion and exclusion criteria, and outcomes. Primary outcome was major postoperative complications (i.e., incomplete pyloromyotomy, perforation, and need for reoperation). Secondary outcomes were time to full feed, postoperative hospital stay, and any other postoperative complications.

Results: Four RCTs with a total of 502 patients (OP 255, LP 247) fulfilled the inclusion criteria and were analyzed in this review. These trials showed an absolute incidence of major postoperative complications of 4.9% in the LP group. Meta-analysis showed that LP did not lead to significantly more major postoperative complications (ARR 3%, 95% CI -3 to 8%) than OP. The mean difference in time to full feed was significant (2.27 h, 95% CI -4.26 to -0.29 h) and the mean difference in postoperative hospital stay tended to be shorter (2.41 h, 95% CI -6.10 to 1.28 h), both in favor of LP.

Conclusion: So far, the major postoperative complication rate after LP for HPS is not substantially higher than after OP. Because time to full feed and postoperative hospital stay are at best a few hours shorter after LP than after OP, the laparoscopic technique might be acknowledged as the standard of care if the major postoperative complication rate is low. Hence, this laparoscopic procedure should preferably be performed in centers with pediatric surgeons with expertise in this procedure.

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Figures

Fig. 1
Fig. 1
Number of articles identified and screened in the systematic review
Fig. 2
Fig. 2
Forest plot of major postoperative complications in infants treated with OP and LP
Fig. 3
Fig. 3
Forest plot of all postoperative complications
Fig. 4
Fig. 4
Forest plot of time to full feed in hours
Fig. 5
Fig. 5
Forest plot of length of postoperative stay in hours
See this image and copyright information in PMC

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