Laparoscopic Vs Open Pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis: A Retrospective Study

Background: The gold standard procedure for treatment of infantile hypertrophic pyloric stenosis is Open Pyloromyotomy. The objective of this study was to compare the results of Laparoscopic Pyloromyotomywith the open procedure by means of a retrospective study of cases operated by both surgical techniques. Methods: A comparative study of cases operated by laparoscopic extramucosalpyloromyotomies(LP) between 2011-2016 was done with open pyloromyotomies (OP) performed during the same period with regard to gender, age at operation, electrolyte levels, thickness and length of hypertrophied pyloric muscle, operating time, number of days to start feeds, time of return to full feeding, frequency of postoperative emesis, surgical complications (i.e., incomplete pyloromyotomy, perforation, and need for reoperation ) and duration of stay in hospital.Eighty cases (44 open, 36 LP) which fulfilled the inclusion criteria were analyzed in the study. Results: The groups were matched for gender more common in male child (78 %), mean age at time of surgery was 6 weeks, and 25% had severe electrolyte imbalance requiring correction. Mean size of the hypertrophied pylorus assessed by ultrasonography was 4.8mm thickness, Length 21.5mm. Mean operating time for Laparoscopic surgeries compared to open procedure didn’t have a significant difference (42min: 40min). Average time taken for first feeds after surgery (8.5 hrs: 18.5hrs) and time for full feeding (30hrs: 64hrs) was significantly shorter in the LP group than the OP group. Postoperative emesis was seen in 80% of cases operated by Laparoscopic procedure compared to 40% in open cases. The mean length of hospitalization was significantly shorter in LP group (5days: 8days). One death was noted in a case operated by laparoscopic approach and one case operated by Laparoscopy had wound site infection near the Umbilical port. Conclusion: When compared with open pyloromyotomy, the laparoscopic approach appears to be equally safe and effective, with shorter time to start feeds, reach full feeds, shorter hospital stay and with superior cosmetic results. The authors believe that laparoscopic pyloromyotomy is a equally good alternative procedure for the management of hypertrophic pyloric stenosis.