Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis-A Systematic Review and Meta-Analysis

Fabian Lunger; Ralph F Staerkle; Julian L Muff; Lukas Fink; Stefan G Holland-Cunz; Raphael N Vuille-Dit-Bille

doi:10.1016/j.jss.2021.12.042

Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis-A Systematic Review and Meta-Analysis

J Surg Res. 2022 Jun:274:1-8. doi: 10.1016/j.jss.2021.12.042. Epub 2022 Feb 2.

Authors

Fabian Lunger¹, Ralph F Staerkle², Julian L Muff³, Lukas Fink⁴, Stefan G Holland-Cunz³, Raphael N Vuille-Dit-Bille⁵

Affiliations

¹ Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland; Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland.
² Department of Surgery, Clinic for Visceral Surgery, University Hospital Basel, Basel, Switzerland.
³ Department of Pediatric Surgery, Children's University Hospital, Basel, Switzerland.
⁴ Department of Mathematics, Cantonal School of Wil, St. Gallen, Switzerland.
⁵ Department of Pediatric Surgery, Children's University Hospital, Basel, Switzerland. Electronic address: rnvuille@gmail.com.

PMID: 35104694
DOI: 10.1016/j.jss.2021.12.042

Abstract

Introduction: Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the open versus laparoscopic technique.

Methods: A literature search was conducted from 1990 to February 2021 using the electronic databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Primary outcomes were mucosal perforation and incomplete pyloromyotomy. Secondary outcomes consisted of length of hospital stay, time to full feeds, operating time, postoperative wound infection/abscess, incisional hernia, hematoma/seroma formation, and death.

Results: Seven randomized controlled trials including 720 patients (357 with OP and 363 with LP) were included. Mucosal perforation rate was not different between groups (relative risk [RR] LP versus OP 1.60 [0.49-5.26]). LP was associated with nonsignificant higher risk of incomplete pyloromyotomy (RR 7.37 [0.92-59.11]). There was no difference in neither postoperative wound infections after LP compared with OP (RR 0.59 [0.24-1.45]) nor in postoperative seroma/hematoma formation (RR 3.44 [0.39-30.43]) or occurrence of incisional hernias (RR 1.01 [0.11-9.53]). Length of hospital stay (-3.01 h for LP [-8.39 to 2.37 h]) and time to full feeds (-5.86 h for LP [-15.95 to 4.24 h]) were nonsignificantly shorter after LP. Operation time was almost identical between groups (+0.53 min for LP [-3.53 to 4.59 min]).

Conclusions: On a meta-level, there is no precise effect estimate indicating that LP carries a higher risk for mucosal perforation or incomplete pyloromyotomies compared with the open equivalent. Because of very low certainty of evidence, we do not know about the effect of the laparoscopic approach on postoperative wound infections, postoperative hematoma or seroma formation, incisional hernia occurrence, length of postoperative stay, time to full feeds, or operating time.

Keywords: Hypertrophic pyloric stenosis; Laparoscopic pyloromyotomy; Meta-analysis; Open pyloromyotomy; Systematic review.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Abscess / surgery
Hematoma / surgery
Humans
Incisional Hernia* / epidemiology
Incisional Hernia* / etiology
Incisional Hernia* / surgery
Infant
Laparoscopy* / adverse effects
Laparoscopy* / methods
Pyloric Stenosis, Hypertrophic* / surgery
Pyloromyotomy* / adverse effects
Pyloromyotomy* / methods
Pylorus / surgery
Seroma
Surgical Wound Infection / epidemiology
Surgical Wound Infection / etiology
Surgical Wound Infection / surgery