Pyloromyotomy: a comparison of laparoscopic, circumumbilical, and right upper quadrant operative techniques.
BACKGROUND
Ramstedt pyloromyotomy through a right upper quadrant (RUQ) transverse incision has been the traditional treatment for hypertrophic pyloric stenosis. Recently, laparoscopic (LAP) and circumumbilical (UMB) approaches have been introduced as alternative methods to improve cosmesis, but concerns about greater operative times, costs, and complications remain. This study compares the three operative techniques and examines their advantages and complication rates.


METHODS
We performed a retrospective review of patients undergoing pyloromyotomy at a children's hospital between January 1997 and June 2003.


RESULTS
Two hundred ninety patients underwent pyloromyotomy by LAP (n = 51), RUQ (n = 190), or UMB (n = 49). Complication rate, time to ad libitum feeding, incidence of emesis, and postoperative length of stay did not differ considerably among groups. Two LAP patients were converted to RUQ. Mucosal perforation occurred in three patients each in the RUQ and UMB groups, but none in the LAP group. Operative times were considerably less for LAP (25 +/- 9 minutes) than for RUQ (32 +/- 9 minutes) and UMB (42 +/- 12 minutes) (p < 0.05, ANOVA, Bonferroni). Charges related to operations and anesthesia were considerably greater for UMB (operation: US 1,574 dollars +/- US 433 dollars; anesthesia: US 731 dollars +/- US 190 dollars) compared with the other two groups (p < 0.05, ANOVA, Bonferroni), but did not differ between LAP (operation: US 1,299 dollars +/- US 311 dollars; anesthesia: US 586 dollars +/- US 137 dollars) and RUQ (operation: US 1,237 dollars +/- US 411 dollars; anesthesia: US 578 dollars +/- US 167 dollars). Data are presented as mean +/- SD.


CONCLUSIONS
Advantages of LAP include a shorter mean operative time without higher complications or costs. UMB is associated with the greatest mean operative time and costs. Laparoscopic pyloromyotomy is a safe and effective approach to the treatment of hypertrophic pyloric stenosis.
Department of Surgery, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, WA 98105, USA.
Stephen S
SS
Kim
Stanley T
ST
Lau
Steven L
SL
Lee
Robert
R
Schaller
Patrick J
PJ
Healey
Daniel J
DJ
Ledbetter
Robert S
RS
Sawin
John H T
JH
Waldhausen
D000005:Abdomen / Q000601:surgery*; D000768:Anesthesia, General / Q000191:economics; D004435:Eating / Q000502:physiology; D005260:Female; D005753:Gastric Mucosa / Q000293:injuries; D017722:Hospital Charges; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014472:Umbilicus / Q000601:surgery*