Original article Retrospective comparison of open versus laparoscopic pyloromyotomy N. J. Hall, N. Ade-Ajayi, J. Al-Roubaie, J. Curry, E. M. Kiely and A. Pierro Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, 30 Guilford Street, London WC1N 1EH, UK Correspondence to: Professor A. Pierro (e-mail: a.pierro@ich.ucl.ac.uk) Background: Laparoscopic pyloromyotomy is gaining popularity in the management of pyloric stenosis. However, there is no unequivocal evidence in favour of the laparoscopic over the open approach. This paper reports an experience with laparoscopic pyloromyotomy and an attempt to identify any benefit over the open procedure. Methods: This was a retrospective review of all 87 pyloromyotomies performed at this institution for pyloric stenosis over the 39 months since the first laparoscopic pyloromyotomy was performed. Results: Data for 39 infants who underwent laparoscopic pyloromyotomy were compared with those for 38 infants who underwent pyloromyotomy via a periumbilical incision. Patient demographics were similar between the two groups. The duration of operation was longer for laparoscopic pyloromyotomy than for the open procedure (median 50 versus 30 min; P = 0·001). There were no differences in recovery time, postoperative length of hospital stay, complication rates and postoperative analgesia requirements between the two groups. Conclusion: Laparoscopic pyloromyotomy has been incorporated successfully into the authors’ standard working practice. Complication rates and recovery times were similar to those achievable with the open procedure. There was no clear benefit of one approach over the other. Paper accepted 5 February 2004 Published online 16 August 2004 in Wiley InterScience (www.bjs.co.uk). DOI: 10.1002/bjs.4523 Introduction Infantile hypertrophic pyloric stenosis is a common condition of infancy, with an incidence of approximately 1–3 per 1000 live births 1 . It is one of the most common conditions requiring surgical intervention in early life. The surgical operation of choice is pyloromyotomy, first described by Ramstedt in the early 1900s 2 ; the hypertrophic muscle of the pylorus is split leaving the mucosa intact, thereby permitting gastric emptying. The operation has a high success rate, a low incidence of complications and can be performed quickly, ensuring minimal anaesthetic time in a young infant. These factors have no doubt contributed to its popularity and success over the years. As a result of concern over the cosmetic result, the surgical access to the peritoneal cavity has evolved from a vertical midline incision to a transverse incision in the right upper quadrant and subsequently to a periumbilical incision. A laparoscopic approach to pyloromyotomy was described in the 1990s 3 . Its potential advantages include shorter recovery time and improved cosmesis, but its superiority over the open approach has not been demonstrated unequivocally. A number of centres around the world have reported experience with this technique 4–12 but it has not gained widespread popularity in the UK 13 . The present authors have been using laparoscopic pyloromyotomy since the latter part of 1999 and report their experience to date. Patients and methods Data collection A retrospective case-note review of all infants who underwent pyloromyotomy for pyloric stenosis between October 1999 and December 2002 was completed. During this period the choice of surgical approach was at the discretion of the operating surgeon. Demographic and operative details were recorded. Additional data on postoperative course were retrieved for comparison Copyright  2004 British Journal of Surgery Society Ltd British Journal of Surgery 2004; 91: 1325–1329 Published by John Wiley & Sons Ltd Downloaded from https://academic.oup.com/bjs/article/91/10/1325/6151033 by guest on 15 October 2023