Open versus laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis

Objectives: The aim of this meta-analysis is to compare the efficacy and safety of open versus laparoscopic pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis. Methods: We performed a systematic literature search, using PubMed, The Cochrane Library, Embase, for randomized studies comparing open pyloromyotomy and laparoscopic pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis. We conducted meta-analysis when possible and described other outcomes narratively. Results: Six randomized controlled clinical trials were included, with a total of 680 infants (343 in the laparoscopic group, 337 in the open group). The results of our meta-analysis showed no significant differences in overall complications between the groups (RR 1.05, P=0.84, 95% CI: 0.67 to 1.64); major complications (RR 2.01, P=0.10, 95% CI: 0.87 to 4.62); operating time (SMD: -1.21, P=0.44, 95% CI: -0.74 to 0.32). The laparoscopic group was associated with a higher incidence of incomplete pyloromyotomy (RR 6.57, P=0.03, 95% CI: 1.19 to 36.22). Patients who underwent laparoscopic pyloromyotomy had a shorter time to reach full feeding (SMD: -0.40, P=0.006, 95% CI: -0.69 to -0.11), shorter length of postoperative hospital stay (SMD: -0.18, P=0.04, 95% CI: -0.36 to -0.01). Results from two RCTs showed a better cosmetic outcome after laparoscopic pyloromyotomy compared to open procedure. Three other RCTs indicated a higher score of postoperative pain and more doses of analgesic drugs are needed after the open technique. Conclusion: Our meta-analysis demonstrates that both LP and OP are equally safe and effective techniques for the surgical management of IHPS, with LP being associated with a shorter time to reach full feeds; shorter length of postoperative hospital stay; better cosmetic outcome, and less postoperative pain.