Meta-analysis of Laparoscopic Versus Open Pyloromyotomy

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Abstract
To perform a meta-analysis of studies comparing open pyloromyotomy (OP) and laparoscopic pyloromyotomy (LP) in the treatment of infantile hypertrophic pyloric stenosis. LP has become increasingly popular for the management of pyloric stenosis. Despite a decade of experience, the real benefit of LP over the open procedure remains unclear. Using a defined search strategy, studies directly comparing OP with LP were identified (n = 8). Data for infants treated by both approaches were extracted and used in our meta-analysis. OP and LP were compared in terms of complications, efficacy, operating time, and recovery time. Weighted mean difference (WMD) between continuous variables and 95% confidence intervals (95% CI) were calculated. For dichotomous data, relative risk (RR) and 95% CI were determined. Only 3 studies were prospective, and just 1 study was a prospective randomized controlled trial. Mucosal perforations and incomplete pyloromyotomy were both more common with LP. Compared with OP, LP is associated with higher complication rate (RR 0.81 [0.5, 1.29], P = 0.4), similar operating time (WMD 1.52 minutes [-0.26, 3.29], P = 0.09), shorter time to full feeds (WMD 8.66 hours [7.25, 10.07], P < 0.00001), and shorter postoperative length of stay (WMD 7.03 hours [3.74, 10.32], P = 0.00003). OP is associated with fewer complications and higher efficacy. Recovery time appears significantly shorter following LP. A prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.