title: Differential learning processes for laparoscopic and open supraumbilical pyloromyotomy.
abstract: OBJECTIVE
  To compare the learning curves for mastering OP and LP surgical techniques, in terms of effects on completion times and postoperative outcomes/complications.
  
  
  METHODS
  A retrospective analysis was performed for 198 patients with hypertrophic pyloric stenosis. The learning curves were in regard to two groups of surgeons: three of whom performed 106 OPs while three others performed 92 LPs. Treatment-related complications were divided into two categories: specific complications relating to the pyloromyotomy and non-specific complications. A logistic regression model with repeated data was used to explore the occurrence of complications.
  
  
  RESULTS
  The overall postoperative complication rates were not significantly different between the OP (15.1 %) and the LP (11.8 %) groups. Specific complications were more frequent in the LP group (6.4 versus 2.8 %), while non-specific complications were more frequent in the OP group (12.1 versus 5.3 %). The occurrence of complications exhibited a statistically decreasing risk with each supplementary procedure that was performed (p = 0.0067) in the LP group, but not in the OP group (p = 0.9665).
  
  
  CONCLUSIONS
  From a learning process perspective, laparoscopy is mainly associated with a significantly higher risk of specific complications. This risk decreases in line with the surgeon's level of experience, whereas non-specific complications remain stable in open procedures.
authors.affiliation: University Hospital, Limoges, France. q.ballouhey@gmail.com.
authors.forename: Quentin
authors.initials: Q
authors.lastname: Ballouhey
authors.affiliation: University Hospital, Limoges, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Clermidi
authors.affiliation: University Hospital, Limoges, France.
authors.forename: Alexia
authors.initials: A
authors.lastname: Roux
authors.affiliation: University Hospital, Limoges, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bahans
authors.affiliation: University Hospital, Limoges, France.
authors.forename: Roxane
authors.initials: R
authors.lastname: Compagnon
authors.affiliation: University Hospital, Limoges, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cros
authors.affiliation: University Hospital, Limoges, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Longis
authors.affiliation: University Hospital, Limoges, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fourcade
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D066231:Surgeons / Q000193:education*; D016896:Treatment Outcome
keywords: Laparoscopy; Learning curve; Pediatric; Pyloric stenosis