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Logo of archdischArchives of Disease in ChildhoodVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Arch Dis Child. 2007 May; 92(5): 461.
PMCID: PMC2083729

Open versus laparoscopic pyloromyotomy

Ramstedt described the operation of pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis in 1912. The traditional operation is performed through a right upper quadrant incision that may become unsightly. Other incisions may give better cosmetic results but be prone to more wound complications. Laparoscopic pyloromyotomy was introduced in 1991; initial access is through the umbilicus and instruments are placed through tiny incisions in the left and right upper quadrants. A retrospective review of laparoscopic and open operations has been reported from the Children's Hospital of Philadelphia (Obinna Adibe and colleagues. Journal of Pediatric Surgery 2006;41:1676–8).

Over a 5 year period there were 212 laparoscopic and 123 open pyloromyotomies. Five patients in the laparoscopic group needed conversion to an open operation. The results of the two operations were similar as regards mean operating time (laparoscopic 30.5 min, open 32.0 min), time to full feeds (22.4 vs 23.5 h), episodes of postoperative vomiting (1.8 vs 2.2) and duration of hospital stay (49.3 vs 50.5 h). Mucosal perforation occurred in five patients in the laparoscopic group and in two in the open group. Incomplete pyloromyotomy occurred in three patients in the laparoscopic group versus none in the open group. In the laparoscopic group all of the incomplete myotomies and all but one of the perforations occurred within 2 years of the introduction of the laparoscopic operation to the hospital.

In a high‐volume tertiary care unit laparoscopic pyloromyotomy is as safe and effective as the open operation, but there may be an initial learning curve with increased risk of mucosal perforation or incomplete myotomy.


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