title: Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine whether open or laparoscopic pyloromyotomy is superior for the treatment of hypertrophic pyloric stenosis in infants.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and CENTRAL for articles comparing laparoscopic and open procedures. We conducted meta-analyses when possible and described other results narratively.
  
  
  RESULTS
  Our meta-analyses revealed no significant difference in our primary outcome of major complications [risk difference (RD) 0.03, 95% confidence interval (CI) -0.03 to 0.08, P = 0.35, I2= 55%], or in our secondary outcomes of all perioperative complications (RD -0.01, 95% CI -0.06 to 0.04, P = 0.74, I2= 0%), operative time [mean difference (MD) 0.68, 95% CI -3.60 to 4.79, P = 0.76, I2= 86%], and length of stay (MD -2.60, 95% CI -6.05 to 0.86, P = 0.14, I2= 0%). Laparoscopy was associated with a shorter time to full feeds (standardized mean difference -0.25, 95% CI -0.43 to -0.06, P = 0.009, I2= 8%) and a slightly higher rate of inadequate pyloromyotomy (RD 0.04, 95% CI 0.00-0.08, P = 0.03, I2= 0%). Results from one randomized controlled trial indicate a better cosmetic outcome after laparoscopy compared to open procedure.
  
  
  CONCLUSIONS
  There is no strong evidence to support a recommendation of one procedure over the other; therefore, the choice of laparoscopic or open procedure should be left to the discretion of the surgeon.
authors.affiliation: Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors.forename: Chethan
authors.initials: C
authors.lastname: Sathya
authors.affiliation: Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wayne
authors.affiliation: Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Gotsch
authors.affiliation: Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vincent
authors.affiliation: Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Sullivan
authors.affiliation: Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. anasr@cheo.on.ca.|University of Ottawa, Ottawa, ON, Canada. anasr@cheo.on.ca.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*
keywords: Hypertrophic pyloric stenosis; Laparoscopic surgery; Meta-analysis; Minimally invasive surgery; Pediatric surgery; Systematic review