• Nigel J Hall, Jill Van Der Zee, Hock L Tan, and Agostino Pierro.
• Department of Paediatric Surgery, Great Ormond Street Hospital, and the Institute of Child Health, London, United Kingdom.
• Ann. Surg. 2004 Nov 1; 240 (5): 774778774-8.

ObjectiveTo perform a meta-analysis of studies comparing open pyloromyotomy (OP) and laparoscopic pyloromyotomy (LP) in the treatment of infantile hypertrophic pyloric stenosis.BackgroundLP has become increasingly popular for the management of pyloric stenosis. Despite a decade of experience, the real benefit of LP over the open procedure remains unclear.MethodsUsing a defined search strategy, studies directly comparing OP with LP were identified (n = 8). Data for infants treated by both approaches were extracted and used in our meta-analysis. OP and LP were compared in terms of complications, efficacy, operating time, and recovery time. Weighted mean difference (WMD) between continuous variables and 95% confidence intervals (95% CI) were calculated. For dichotomous data, relative risk (RR) and 95% CI were determined.ResultsOnly 3 studies were prospective, and just 1 study was a prospective randomized controlled trial. Mucosal perforations and incomplete pyloromyotomy were both more common with LP. Compared with OP, LP is associated with higher complication rate (RR 0.81 [0.5, 1.29], P = 0.4), similar operating time (WMD 1.52 minutes [-0.26, 3.29], P = 0.09), shorter time to full feeds (WMD 8.66 hours [7.25, 10.07], P < 0.00001), and shorter postoperative length of stay (WMD 7.03 hours [3.74, 10.32], P = 0.00003).ConclusionsOP is associated with fewer complications and higher efficacy. Recovery time appears significantly shorter following LP. A prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.

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