title: Risk of incomplete pyloromyotomy and mucosal perforation in open and laparoscopic pyloromyotomy.
abstract: BACKGROUND
  Despite randomized controlled trials and meta-analyses, it remains unclear whether laparoscopic pyloromyotomy (LP) carries a higher risk of incomplete pyloromyotomy and mucosal perforation compared with open pyloromyotomy (OP).
  
  
  METHODS
  Multicenter study of all pyloromyotomies (May 2007-December 2010) at nine high-volume institutions. The effect of laparoscopy on the procedure-related complications of incomplete pyloromyotomy and mucosal perforation was determined using binomial logistic regression adjusting for differences among centers.
  
  
  RESULTS
  Data relating to 2830 pyloromyotomies (1802 [64%] LP) were analyzed. There were 24 cases of incomplete pyloromyotomy; 3 in the open group (0.29%) and 21 in the laparoscopic group (1.16%). There were 18 cases of mucosal perforation; 3 in the open group (0.29%) and 15 in the laparoscopic group (0.83%). The regression model demonstrated that LP was a marginally significant predictor of incomplete pyloromyotomy (adjusted difference 0.87% [95% CI 0.006-4.083]; P=0.046) but not of mucosal perforation (adjusted difference 0.56% [95% CI -0.096 to 3.365]; P=0.153). Trainees performed a similar proportion of each procedure (laparoscopic 82.6% vs. open 80.3%; P=0.2) and grade of primary operator did not affect the rate of either complication.
  
  
  CONCLUSIONS
  This is one of the largest series of pyloromyotomy ever reported. Although laparoscopy is associated with a statistically significant increase in the risk of incomplete pyloromyotomy, the effect size is small and of questionable clinical relevance. Both OP and LP are associated with low rates of mucosal perforation and incomplete pyloromyotomy in specialist centers, whether trainee or consultant surgeons perform the procedure.
authors: UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK. Electronic address: nigel.hall@ucl.ac.uk.
authors: Nigel J
authors: NJ
authors: Hall
authors: UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.
authors: Simon
authors: S
authors: Eaton
authors: Riley Hospital for Children, Indianapolis, IN.
authors: Aaron
authors: A
authors: Seims
authors: Riley Hospital for Children, Indianapolis, IN.
authors: Charles M
authors: CM
authors: Leys
authors: The Children's Hospital of Wisconsin, Medical College ofWisconsin, Milwaukee, WI.
authors: John C
authors: JC
authors: Densmore
authors: The Children's Hospital of Wisconsin, Medical College ofWisconsin, Milwaukee, WI.
authors: Casey M
authors: CM
authors: Calkins
authors: Children's Mercy Hospital, Kansas City, MO.
authors: Daniel J
authors: DJ
authors: Ostlie
authors: Children's Mercy Hospital, Kansas City, MO.
authors: Shawn D
authors: SD
authors: St Peter
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Richard G
authors: RG
authors: Azizkhan
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Daniel
authors: D
authors: von Allmen
authors: Hospital for Sick Children and University of Toronto, Toronto, Canada.
authors: Jacob C
authors: JC
authors: Langer
authors: Hospital for Sick Children and University of Toronto, Toronto, Canada.
authors: Eveline
authors: E
authors: Lapidus-Krol
authors: Hospital Sainte-Justine, Montreal, Canada.
authors: Sarah
authors: S
authors: Bouchard
authors: Hospital Sainte-Justine, Montreal, Canada.
authors: Nelson
authors: N
authors: Piché
authors: University of Michigan, Ann Arbor, MI.
authors: Steven
authors: S
authors: Bruch
authors: University of Michigan, Ann Arbor, MI.
authors: Robert
authors: R
authors: Drongowski
authors: Royal Hospital for Sick Children, Edinburgh, UK.
authors: Gordon A
authors: GA
authors: MacKinlay
authors: Royal Hospital for Sick Children, Edinburgh, UK.
authors: Claire
authors: C
authors: Clark
authors: UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK; Hospital for Sick Children and University of Toronto, Toronto, Canada.
authors: Agostino
authors: A
authors: Pierro
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000293:injuries*; D007416:Intestinal Perforation / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011707:Pyloric Stenosis / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies
keywords: Infant; Minimally invasive surgery; Pyloric stenosis; Pyloromyotomy