American Surgical Association
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Open Versus Laparoscopic Pyloromyotomy For Pyloric Stenosis: A Prospective Randomized Trial
Shawn D. St. Peter, MD*, George W. Holcomb, III, MD, Casey M. Calkins, MD*, Walter S. Andrews, MD*, J Patrick Murphy, MD*, Charles L. Snyder, MD*, Ronald J. Sharp, MD*, Daniel J. Ostlie, MD*
Children's Mercy Hospital, Kansas City, MO

Pyloric stenosis, the most common surgical condition of infants, is treated by longitudinal myotomy of the hypertrophied pylorus. Comparative studies to date between open (OP) and laparoscopic (LP) pyloromyotomy have been retrospective and report conflicting results. To scientifically compare the two techniques, we conducted the first large prospective, randomized trial.
METHODS
After obtaining IRB approval, subjects with ultrasound-proven pyloric stenosis were randomized to OP or LP. Post-operative pain management, feeding schedule, and discharge criteria were identical for both groups. Operating time, post-operative emesis, analgesia requirements, time to full feeding, length of hospitalization after operation, and complications were compared.
RESULTS
From 4/2003 through 11/2005, 160 (82 OP and 78 LP) of the intended 200 patients have completed the study. There were no significant differences in operating time, emesis episodes, time to full feeding, or postoperative length of hospitalization (Table1). There were significantly fewer doses of analgesia given in the LP group. One mucosal perforation and one incisional hernia occurred in the OP group. Wound infection occurred in 4.9% and 2.6% of the OP and LP patients respectively (P = 0.37).
CONCLUSION
There is no difference in operating time or postoperative recovery between OP and LP. However, LP results in less postoperative pain. In addition, there were fewer complications in the LP group, and this group will likely have a superior cosmetic outcome with long-term follow-up.
Table 1
Open (N=82) Mean +/- Standard ErrorLaparoscopic (N=78) Mean +/- Standard ErrorP-Value
Age (Weeks)5.18 +/- 0.285.25 +/- 0.220.85
Pre-Op Pyloric Thickness (mm)4.16 +/- 0.084.18 +/- 0.100.87
Pre-Op Pyloric Length (mm)19.57 +/- 0.2919.27 +/- 0.300.49
Operating Time (Minutes)18.91 +/- 5.9319.50 +/- 7.470.58
Post-Operative Emesis (Number)2.54 +/- 0.371.95 +/- 0.250.19
Time to Full Feeds (Hours)19.96 +/- 1.3719.94+/- 1.650.90
Doses of Analgesia (Number)2.07 +/- 0.191.37 +/- 0.160.005
Length of Stay after Operation (Hours)32.66 +/- 1.7030.59 +/- 1.960.32


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