Pyloromyotomy: A comparison of laparoscopic, circumumbilical, and right upper quadrant operative techniques

BACKGROUND: Ramstedt pyloromyotomy through a right upper quadrant (RUQ) transverse incision has been the traditional treatment for hypertrophic pyloric stenosis. Recently, laparoscopic (LAP) and circumumbilical (UMB) approaches have been introduced as alternative methods to improve cosmesis, but concerns about greater operative times, costs, and complications remain. This study compares the three operative techniques and examines their advantages and complication rates. STUDY DESIGN: We performed a retrospective review of patients undergoing pyloromyotomy at a children's hospital between January 1997 and June 2003. RESULTS: Two hundred ninety patients underwent pyloromyotomy by LAP (n = 51), RUQ (n = 190), or UMB (n = 49). Complication rate, time to ad libitum feeding, incidence of emesis, and postoperative length of stay did not differ considerably among groups. Two LAP patients were converted to RUQ Mucosal perforation occurred in three patients each in the RUQ and UMB groups, but none in the LAP group. Operative times were considerably less for LAP (25 +/- 9 minutes) than for RUQ (32 +/- 9 minutes) and UMB (42 +/- 12 minutes) (P < 0.05, ANOVA, Bonferroni). Charges related to operations and anesthesia were considerably greater for UMB (operation: $1,574 +/- $433; anesthesia: $731 +/- $190) compared with the other two groups (p < 0.05, ANOVA, Bonferroni), but did not differ between LAP (operation: $1,299 +/- $311; anesthesia: $586 +/- $137) and RUQ (operation: $1,237 +/- $411; anesthesia: $578 +/- $167 Data are presented as mean +/- SD. CONCLUSIONS: Advantages of LAP include a shorter mean operative time without higher complications or costs. UMB is associated with the greatest mean operative time and costs. Laparoscopic pyloromyotomy is a safe and effective approach to the treatment of hypertrophic pyloric stenosis. (c) 2005 by the American College of Surgeons.