Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a prospective, randomized controlled trial.
BACKGROUND
Several authors have reported on laparoscopic pyloromyotomy (LP) since the technique was originally described in 1990, but its benefits remain unproven. We performed a randomized controlled trial comparing LP to open circumumbilical pyloromyotomy (OP) for hypertrophic pyloric stenosis.


METHODS
In a prospective study, 102 infants with pyloric stenosis were randomly assigned to either LP (n = 50) or OP (n = 52). The primary outcome measure was the incidence of postoperative vomiting; the secondary parameters were the durations of surgery and anesthesia, surgical complications, and postoperative pain. All infants were managed according to standardized procedures regarding general anesthesia, surgical technique, postoperative analgesia, and feeding regimen. Parents, carers, and assessors responsible for the postoperative evaluation were blinded for the technique used.


RESULTS
There was no difference in the incidence of postoperative vomiting between the 2 groups. The overall incidence of complications was similar, but the durations of surgery and general anesthesia were significantly longer in the LP group than in the OP group (P = 10(-4) and P = .02, respectively). There were 3 cases of incomplete pyloromyotomy after laparoscopy, requiring a repeat procedure.


CONCLUSIONS
Laparoscopic pyloromyotomy does not decrease the incidence of postoperative vomiting, has a similar complication rate compared with the open umbilical approach, but may expose patients to a risk of inadequate pyloromyotomy.
Leclair
Marc-David
MD
Department of Paediatric Surgery, Hôpital Mère-Enfant, 44093 Nantes, France. marcdavid.leclair@chu-nantes.fr
Plattner
Valérie
V
Mirallie
Eric
E
Lejus
Corinne
C
Nguyen
Jean-Michel
JM
Podevin
Guillaume
G
Heloury
Yves
Y
D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D010149:Postoperative Pain; D011183:Postoperative Complications; D020250:Postoperative Nausea and Vomiting; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*