title: Open transumbilical pyloromyotomy: is it more painful than the laparoscopic approach?
abstract: BACKGROUND
  Open transumbilical pyloromyotomy (UMBP) and laparoscopic pyloromyotomy (LAP) have been compared on different outcomes, but postoperative pain as a primary end point had never been assessed. The aim of this study was to compare the use of analgesia in UMBP and LAP patients.
  
  
  METHODS
  Infants with hypertrophic pyloric stenosis treated by UMBP in 2008-2009 were matched with LAP-treated infants. Demographics, type and use of analgesia, and length of stay were recorded. Statistical analysis was performed using the Fisher exact test.
  
  
  RESULTS
  Each group contained 19 patients (N = 38) with comparable demographics and no comorbid condition. Bupivacaine was injected intraoperatively in all UMBP and 89% of LAP infants. There was a trend toward increased acetaminophen use in LAP infants (79% vs 58%, P = .61) in the recovery room. There was no difference in opiates use (3 UMBP vs 1 LAP, P = .60). In the ward, more UMBP patients received acetaminophen (78% vs 53%, P = .03). This difference was significant. Mean postoperative length of stay was similar in both groups.
  
  
  CONCLUSIONS
  Our study suggests that UMBP infants might experience more postoperative pain in the ward, without any impact on various outcomes. A prospective study with a larger sample size should be undertaken to verify these findings.
authors: Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
authors: Caroline
authors: C
authors: Lemoine
authors: Catherine
authors: C
authors: Paris
authors: Mélanie
authors: M
authors: Morris
authors: Kaveh
authors: K
authors: Vali
authors: Mona
authors: M
authors: Beaunoyer
authors: Ann
authors: A
authors: Aspirot