title: Laparoscopic pyloromyotomy, the tail of the learning curve.
abstract: BACKGROUND
  The debate whether laparoscopic pyloromyotomy (LP) is superior to open pyloromyotomy (OP) remains actual. A recent review showed no benefit between the LP or OP, but in the studied randomized, controlled trials the learning curve was not addressed. Comparing LP including the learning curve with OP after the learning curve is questionable. In previous research, the learning curve of LP was analyzed. It was concluded that the plateau was reached after 35 procedures with a steep decrease in complications when comparing before and after 35 procedures. This study was designed to retrospectively analyze the results obtained in HPS patients after the learning curve in LP has been reached. The results will be compared with results of OP in HPS patients in the same period.
  
  
  METHODS
  A retrospective analysis in 106 OP and 57 LP was performed from September 2008 to June 2012.
  
  
  RESULTS
  The overall complication rate in the OP group was significantly higher than in the LP group (18% vs. 3.5%, p = 0.012). Also there was a higher major complication rate in the OP group (10.4% vs. 1.7%, p = 0.045). The median time to operate was with 28.5 min in OP and 30.0 min in LP (not significant), whereas the LOS was 2 days in both groups (not significant).
  
  
  CONCLUSIONS
  In this study, a further decline in overall and major complications after the learning curve is seen in the LP group, the tail of the learning curve. The debate whether LP is superior to OP is not finished as long as it is not clear whether the minimally invasive operation is beyond the initial or tail of the learning curve.
authors.affiliation: Academic Medical Centre/VU Medical Centre, Pediatric Surgery, Amsterdam, The Netherlands, m.w.oomen@amc.uva.nl.
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oomen
authors.forename: Roel
authors.initials: R
authors.lastname: Bakx
authors.forename: Babette
authors.initials: B
authors.lastname: Peeters
authors.forename: Doeke
authors.initials: D
authors.lastname: Boersma
authors.forename: Marc
authors.initials: M
authors.lastname: Wijnen
authors.forename: Hugo
authors.initials: H
authors.lastname: Heij
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology