Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis

Abstract

Purpose: To determine whether open or laparoscopic pyloromyotomy is superior for the treatment of hypertrophic pyloric stenosis in infants.

Methods: We searched MEDLINE, EMBASE, and CENTRAL for articles comparing laparoscopic and open procedures. We conducted meta-analyses when possible and described other results narratively.

Results: Our meta-analyses revealed no significant difference in our primary outcome of major complications [risk difference (RD) 0.03, 95% confidence interval (CI) -0.03 to 0.08, P = 0.35, I ² = 55%], or in our secondary outcomes of all perioperative complications (RD -0.01, 95% CI -0.06 to 0.04, P = 0.74, I ² = 0%), operative time [mean difference (MD) 0.68, 95% CI -3.60 to 4.79, P = 0.76, I ² = 86%], and length of stay (MD -2.60, 95% CI -6.05 to 0.86, P = 0.14, I ² = 0%). Laparoscopy was associated with a shorter time to full feeds (standardized mean difference -0.25, 95% CI -0.43 to -0.06, P = 0.009, I ² = 8%) and a slightly higher rate of inadequate pyloromyotomy (RD 0.04, 95% CI 0.00-0.08, P = 0.03, I ² = 0%). Results from one randomized controlled trial indicate a better cosmetic outcome after laparoscopy compared to open procedure.

Conclusion: There is no strong evidence to support a recommendation of one procedure over the other; therefore, the choice of laparoscopic or open procedure should be left to the discretion of the surgeon.

Keywords: Hypertrophic pyloric stenosis; Laparoscopic surgery; Meta-analysis; Minimally invasive surgery; Pediatric surgery; Systematic review.