J Korean Assoc Pediatr Surg.  2014 Dec;20(2):43-47. 10.13029/jkaps.2014.20.2.43.

Comparison of Pyloromyotomy with Supraumbilical Incision and Laparoscopic Pyloromyotomy for Hypertrophic Pyloric Stenosis Performed by a Single Surgeon

• Lee JW
• Kim DY
• Kim SC
• Namgoong J
• Hwang JH

• KMID: 1961485
• DOI: http://doi.org/10.13029/jkaps.2014.20.2.43

Abstract

PURPOSE
Hypertrophic pyloric stenosis (HPS) is known to be one of the most common cause of surgery for infants and pyloromyotomy was considered to the standard treatment. There has been an ongoing debate about whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the best option for treating HPS. The aim of this study is to evaluate safety and effectiveness of LP by comparing the clinical results of both surgical strategies performed by single surgeon.
METHODS
Between January 2000 and December 2013, 60 patients who underwent pyloromyotomy at Asan Medical Center performed by a surgeon were followed: open-supraumbilical incision (n=36) and LP (n=24). The parameters included sex, age and body weight at operation. Clinical outcomes included operation time, time to full feeding, postoperative hospital stay, and postoperative complications.
RESULTS
There were no significant differences in characteristics, postoperative hospital stay between the two groups. Time to full feeding was shorter in LP (OP 24.5 hours vs. LP 19.8 hours; p=0.063). In contrast, the mean operation time was longer in LP (OP 37.5 minutes vs. LP 43.5 minutes; p=0.072). Complications such as perforation of mucosal layer (OP 1 vs. LP 0) and wound problems (OP 2 vs. LP 0) were found to be not worse in laparoscopic group as compared with open group.
CONCLUSION
There has no difference both laparoscopic and open-supraumbilical incision in terms of postoperative hospital stay, time to full feeds and frequency of complications.

Keyword

Hypertrophic pyloric stenosis; Pyloromyotomy; Laparoscopy

MeSH Terms

Body Weight
Chungcheongnam-do
Humans
Infant
Laparoscopy
Length of Stay
Postoperative Complications
Pyloric Stenosis, Hypertrophic*
Wounds and Injuries

Figure

• 

  Fig. 1 Incision of supraumbilical open pyloromyotomy (supraumbilical incision) (A) and laparoscopic pyloromyotomy (B).

Reference

1. Everett KV, Capon F, Georgoula C, Chioza BA, Reece A, Jaswon M, et al. Linkage of monogenic infantile hypertrophic pyloric stenosis to chromosome 16q24. Eur J Hum Genet. 2008; 16:1151–1154.

2. Ohshiro K, Puri P. Pathogenesis of infantile hypertrophic pyloric stenosis: recent progress. Pediatr Surg Int. 1998; 13:243–252.

3. Woo JH, Choi KJ. The clinical features and management of IHPS: a comparison between 1980's and 2000's. J Korean Surg Soc. 2010; 78:184–191.

4. Schwartz MZ. Hypertrophic pyloric stenosis. In : Grosfeld JL, Fonkalsrud EW, Coran AG, O'Neill JA, editors. Pediatric surgery. 6th ed. Philadelphia: Mosby;2006. p. 1215–1224.

5. Oomen MW, Hoekstra LT, Bakx R, Ubbink DT, Heij HA. Open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a systematic review and meta-analysis focusing on major complications. Surg Endosc. 2012; 26:2104–2110.

6. Tan KC, Bianchi A. Circumumbilical incision for pyloromyotomy. Br J Surg. 1986; 73:399.

7. Alain JL, Grousseau D, Terrier G. Extramucosal pyloromyotomy by laparoscopy. Surg Endosc. 1991; 5:174–175.

8. Kim SM, Jung SM, Seo JM, Lee SK. Comparison of outcomes between open and laparoscopic pyloromyotomy. J Korean Assoc Pediatr Surg. 2011; 17:139–144.

9. Hirschsprung H. Falle von angeborener pylorus stenose. J Kinderheilk. 1888; 27:61–62.

10. Fujimoto T, Lane GJ, Segawa O, Esaki S, Miyano T. Laparoscopic extramucosal pyloromyotomy versus open pyloromyotomy for infantile hypertrophic pyloric stenosis: which is better? J Pediatr Surg. 1999; 34:370–372.

11. St Peter SD, Holcomb GW 3rd, Calkins CM, Murphy JP, Andrews WS, Sharp RJ, et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg. 2006; 244:363–370.

12. Jung H, Jang JH, Jo AH, Kim SH, Jung SE, Park KW, et al. Laparoscopic versus open pyloromyotomy for hypertrophic pyloric stenosis. J Minim Invasive Surg. 2013; 16:11–14.

13. Yagmurlu A, Barnhart DC, Vernon A, Georgeson KE, Harmon CM. Comparison of the incidence of complications in open and laparoscopic pyloromyotomy: a concurrent single institution series. J Pediatr Surg. 2004; 39:292–296.

14. Adibe OO, Nichol PF, Flake AW, Mattei P. Comparison of outcomes after laparoscopic and open pyloromyotomy at a high-volume pediatric teaching hospital. J Pediatr Surg. 2006; 41:1676–1678.

15. Ostlie DJ, Woodall CE, Wade KR, Snyder CL, Gittes GK, Sharp RJ, et al. An effective pyloromyotomy length in infants undergoing laparoscopic pyloromyotomy. Surgery. 2004; 136:827–832.

16. Campbell BT, McVay MR, Lerer TJ, Lowe NJ, Smith SD, Kokoska ER. Ghosts in the machine: a multi-institutional comparison of laparoscopic and open pyloromyotomy. J Pediatr Surg. 2007; 42:2026–2029.

17. Campbell BT, McLean K, Barnhart DC, Drongowski RA, Hirschl RB. A comparison of laparoscopic and open pyloromyotomy at a teaching hospital. J Pediatr Surg. 2002; 37:1068–1071.

18. Sitsen E, Bax NM, van der Zee DC. Is laparoscopic pyloromyotomy superior to open surgery? Surg Endosc. 1998; 12:813–815.

19. Spitz L. Vomiting after pyloromyotomy for infantile hypertrophic pyloric stenosis. Arch Dis Child. 1979; 54:886–889.

20. Schärli AF, Leditschke JF. Gastric motility after pyloromyotomy in infants. A reappraisal of postoperative feeding. Surgery. 1968; 64:1133–1137.