Skip to main content
Log in

Laparoscopic pyloromyotomy, the tail of the learning curve

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The debate whether laparoscopic pyloromyotomy (LP) is superior to open pyloromyotomy (OP) remains actual. A recent review showed no benefit between the LP or OP, but in the studied randomized, controlled trials the learning curve was not addressed. Comparing LP including the learning curve with OP after the learning curve is questionable. In previous research, the learning curve of LP was analyzed. It was concluded that the plateau was reached after 35 procedures with a steep decrease in complications when comparing before and after 35 procedures. This study was designed to retrospectively analyze the results obtained in HPS patients after the learning curve in LP has been reached. The results will be compared with results of OP in HPS patients in the same period.

Methods

A retrospective analysis in 106 OP and 57 LP was performed from September 2008 to June 2012.

Results

The overall complication rate in the OP group was significantly higher than in the LP group (18 % vs. 3.5 %, p = 0.012). Also there was a higher major complication rate in the OP group (10.4 % vs. 1.7 %, p = 0.045). The median time to operate was with 28.5 min in OP and 30.0 min in LP (not significant), whereas the LOS was 2 days in both groups (not significant).

Conclusion

In this study, a further decline in overall and major complications after the learning curve is seen in the LP group, the tail of the learning curve. The debate whether LP is superior to OP is not finished as long as it is not clear whether the minimally invasive operation is beyond the initial or tail of the learning curve.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hall NJ, Pacilli M, Eaton S et al (2009) Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet 373:390–398

    Article  PubMed  Google Scholar 

  2. St Peter SD, Holcomb GW III, Calkins CM et al (2006) Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg 244:363–370

    PubMed  Google Scholar 

  3. Scorpio RJ, Tan HL, Hutson JM (1995) Pyloromyotomy: comparison between laparoscopic and open surgical techniques. J Laparoendosc Surg 5:81–84

    Article  PubMed  CAS  Google Scholar 

  4. Oomen MW, Hoekstra LT, Bakx R et al (2012) Open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a systematic review and meta-analysis focusing on major complications. Surg Endosc 26:2104–2110

    Article  PubMed  CAS  Google Scholar 

  5. Tang B, Hanna GB, Bax NM et al (2004) Analysis of technical surgical errors during initial experience of laparoscopic pyloromyotomy by a group of Dutch pediatric surgeons. Surg Endosc 18:1716–1720

    Article  PubMed  CAS  Google Scholar 

  6. van der Bilt JD, Kramer WL, van der Zee DC et al (2004) Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: impact of experience on the results in 182 cases. Surg Endosc 18:907–909

    Article  PubMed  Google Scholar 

  7. Oomen MW, Hoekstra LT, Bakx R et al (2010) Learning curves for pediatric laparoscopy: how many operations are enough? The Amsterdam experience with laparoscopic pyloromyotomy. Surg Endosc 24:1829–1833

    Article  PubMed  CAS  Google Scholar 

  8. Kehlet H, Slim K (2012) The future of fast-track surgery. Br J Surg 99:1025–1026

    Article  PubMed  CAS  Google Scholar 

  9. Voitk AJ, Tsao SG, Ignatius S (2001) The tail of the learning curve for laparoscopic cholecystectomy. Am J Surg 182:250–253

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

M. W. Oomen, R. Bakx, M. H. W. A.Wijnen, B. Peeters, D. Boersma, and H. A. Heij have no conflict of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthijs Oomen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oomen, M., Bakx, R., Peeters, B. et al. Laparoscopic pyloromyotomy, the tail of the learning curve. Surg Endosc 27, 3705–3709 (2013). https://doi.org/10.1007/s00464-013-2951-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-2951-2

Keywords

Navigation