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

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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.

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Fig. 1

From Moher et al. [15]

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Author notes

    Authors and Affiliations

    1. Department of Surgery, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

      Chethan Sathya, Carolyn Wayne, Anna Gotsch, Jennifer Vincent, Katrina J. Sullivan & Ahmed Nasr

    2. University of Ottawa, Ottawa, ON, Canada

      Ahmed Nasr

    Authors
    1. Chethan Sathya
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    2. Carolyn Wayne
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    3. Anna Gotsch
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    4. Jennifer Vincent
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    5. Katrina J. Sullivan
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    6. Ahmed Nasr
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    Corresponding author

    Correspondence to Ahmed Nasr.

    Additional information

    C. Sathya and C. Wayne contributed equally.

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    Sathya, C., Wayne, C., Gotsch, A. et al. Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis. Pediatr Surg Int 33, 325–333 (2017). https://doi.org/10.1007/s00383-016-4030-y

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    • DOI: https://doi.org/10.1007/s00383-016-4030-y

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