Trends and surgical outcomes of laparoscopic versus open pyloromyotomy
- 263 Downloads
Hypertrophic pyloric stenosis (HPS) is one of the most common pediatric illnesses necessitating surgical intervention. Controversy remains over the optimal surgical approach between laparoscopic pyloromyotomy (LP) and open pyloromyotomy (OP). LP has gained acceptance for management of HPS in an era of expanding minimal access surgical approaches to pediatric conditions. Several studies suggest advantages of LP over OP; however, selection bias and small sample sizes remain a concern. This study compares the outcomes of LP versus OP using propensity score methods.
The 2013–2015 ACS NSQIP Pediatric PUF was queried for all infants undergoing pyloromyotomy. The trend in the proportion of infants undergoing LP was described and perioperative outcomes between the OP and LP cohorts were compared using propensity score weighted regression models.
4847 infants were identified to have undergone surgical pyloromyotomy. The proportion of LP performed increased significantly from 59% in 2013 to 65.5% in 2015 (p < 0.001). LP was associated with lower overall complications (1.4% vs 2.9%) (ORadj 0.52, 95% CI 0.34–0.80), surgical site-related complications (1.1% vs 2.1%) (ORadj 0.52, 95% CI 0.32–0.84), and post-operative length of stay (1.5 days vs 1.9 days) (ORadj 0.89, 95% CI 0.81–0.98) without significant differences in related re-operation (0.9% vs 0.9%) (ORadj 1.01, 95% CI 0.52–1.93) or readmissions (1.4% vs 2.1%) (ORadj 0.73, 95% CI 0.46–1.17).
Our study demonstrates that LP is increasingly utilized for management of hypertrophic pyloric stenosis and is associated with shorter length of stay, and lower odds of surgical site-specific and overall complications without differences in related re-operations. This study supports LP as a safe and effective method for management of HPS.
KeywordsMinimally invasive surgery Pyloromyotomy Pyloric stenosis NSQIP
Compliance with ethical standards
Drs. Kethman, Harris, Hawn, and Wall have no conflicts of interest or financial ties to disclose.
- 3.Ramstedt C (1912) Zur operation der angeborenen pylorus-stenose. Med klinGoogle Scholar
- 6.Oomen MWN, Hoekstra LT, Bakx R, Ubbink DT, Heij HA (2012) Open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a systematic review and meta-analysis focusing on major complications. Surg Endosc 26:2104–2110. https://doi.org/10.1007/s00464-012-2174-y CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Hall NJ, Pacilli M, Eaton S, Reblock K, Gaines BA, Pastor A, Langer JC, Koivusalo AI, Pakarinen MP, Stroedter L, Beyerlein S, Haddad M, Clarke S, Ford H, Pierro A (2009) Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet 373:390–398. https://doi.org/10.1016/S0140-6736(09)60006-4 CrossRefPubMedGoogle Scholar
- 11.St Peter SD, Holcomb GW, Calkins CM, Murphy JP, Andrews WS, Sharp RJ, Snyder CL, Ostlie DJ (2006) Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg 244:363–370. https://doi.org/10.1097/01.sla.0000234647.03466.27 PubMedPubMedCentralCrossRefGoogle Scholar
- 14.Friedman J (2001) Greedy function approximation: a gradient boosting machine. Ann StatGoogle Scholar
- 15.Efron B, Hastie T, Johnstone I (2004) Least angle regression. Ann StatGoogle Scholar
- 16.McCaffrey D, Ridgeway G, Morral A (2004) Propensity score estimation with boosted regression for evaluating causal effects in observational studies. Psychol MethodsGoogle Scholar
- 21.Research C DE and Drug Safety and Availability - FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant womenGoogle Scholar
- 22.American College of Surgeons (2016) User guide for the 2015 ACS NSQIP Pediatric procedure targeted participant use data file (PUF) American College of Surgeons National Surgical Quality Improvement Program-PediatricGoogle Scholar
- 23.Rubin DB (1997) Estimating causal effects from large data sets using propensity scores. Ann Intern Med 127:757. https://doi.org/10.7326/0003-4819-127-8_Part_2-199710151-00064 CrossRefPubMedGoogle Scholar