Postoperative outcomes of open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis

Background: Hypertrophic pyloric stenosis (HPS) is one of the most common indications for non-elective surgery in the neonatal population. Multiple small prospective trials have shown that postoperative outcomes for laparoscopic versus open pyloromyotomy are equivalent or slightly better with the minimally invasive approach. This study uses a prospective national database to compare postoperative complications and length of stay for infants undergoing laparoscopic versus open pyloromyotomy.

Methods: Infants undergoing either open or laparoscopic pyloromyotomy for HPS were identified from the 2013 National Surgical Quality Improvement Project-Pediatric Participant Use File. Post-operative complication rates for an open versus laparoscopic approach were compared using chi square or Fisher's exact test as appropriate. Operative time and post-operative length of stay were compared using the Wilcoxon two-sample test.

Results: A total of 3256 infants were identified from the 2013 and 2014 American College of Surgeons National Surgical Quality Improvement Project-Pediatric Participant Use File who underwent pyloromyotomy for HPS. Of these, 1182 were open and 2074 were laparoscopic. Postoperative outcomes are depicted in Table 2. Laparoscopic pyloromyotomy was associated with statistically significant decrease in overall morbidity (2.4% versus 1.2%, P = 0.007).

Conclusions: We have demonstrated that post-operative outcomes after laparoscopic pyloromyotomy are equivalent or superior to an open approach. The minimally invasive approach to pyloromyotomy is a safe and feasible option in the treatment of HPS in infants.