Impact of surgical approach on outcome in 622 consecutive pyloromyotomies at a pediatric teaching institution.
OBJECTIVE
The aim of this study is to compare the outcome of 3 different approaches to pyloromyotomy in a large single institution series.


METHODS
Records of consecutive patients undergoing pyloromyotomy for an 8-year period were reviewed. Patients' age, sex, weight, operating time, length of stay, number of emeses, and complications were recorded. Variables were compared between right upper quadrant (RUQ), umbilical (UMB), and laparoscopic (LAP) approaches.


RESULTS
Six hundred twenty-two patients were included in the study. Operating time was significantly shorter for LAP and RUQ compared to UMB. Length of stay did not differ between the groups. There were fewer episodes of emesis in the LAP group. There was a trend toward a higher rate of complications in UMB group.


CONCLUSIONS
Outcomes after pyloromyotomy are institution dependent and cannot be generalized. Patient safety is the first concern, followed by patient comfort and cosmesis. Laparoscopic pyloromyotomy can be as fast and efficient as open, without an increased rate of complications, with excellent cosmetic results, and less analgesic requirement. If skill and experience to replicate good outcomes of laparoscopy are not available, open pyloromyotomy is a safer technique. The UMB approach is an alternative method to achieve good cosmesis without laparoscopy in the hands of a surgeon proficient in this method.
Perger
Lena
L
Department of Surgery, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
Fuchs
Julie R
JR
Komidar
Luka
L
Mooney
David P
DP
D019072:Antibiotic Prophylaxis / Q000379:methods; D001835:Body Weight; D005260:Female; D005773:Gastroscopy / Q000379:methods* / Q000639:trends; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods* / Q000639:trends; D007902:Length of Stay; D008297:Male; D009130:Muscle, Smooth / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D046248:Pyloric Stenosis, Hypertrophic / Q000151:congenital / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology