Open versus Laparoscopic Pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis

Abstract

Introduction: Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of vomitingin infancy which can be treated by pyloromyotomy after correction of pH and electrolytes imbalance. Infantilehypertrophic pyloric stenosis (IHPS) is the most common surgical cause of vomiting in infancy which can be treatedby pyloromyotomy after correction of pH and electrolytes imbalance.Aim of work: To Compare between laparoscopic and open (Right upper quadrant incision) approach forpyloromyotomy in the management of infants with infantile hypertrophic pyloric stenosis regard their operativetime, hospital stay, postoperative complications and cosmoses.Patients and methods: A prospective study of 40 patients with IHPS was done. (20 by laparoscopy and 20by open approach) To Compare between laparoscopic and open (Right upper quadrant incision) approach inpyloromyotomy in infants with infantile hypertrophic pyloric stenosis regard their operative time, hospital stay,postoperative complications and cosmoses.Results: This study was conducted on 40 patients with infantile hypertrophic pyloric stenosis (IHPS) randomlydivided into two groups, A and B. Laparoscopic pyloromyotomy was performed on group A while Group B underwentopen pyloromyotomy through a transverse right upper quadrant incision. Throughout the study, 31 (77.5%) malebabies were diagnosed with IHPS, while only 9 (22.5%) female babies were diagnosed during the study with 3.4:1male to female Ratio. Open pyloromyotomy needed less operative time (mean 28.6 mins ), while laparoscopicpyloromyotomy took more time ( Mean 36.8 mins ) intraoperatively and needs more experience for the surgeonin dealing with laparoscopic tools. According to the study, Patients underwent open pyloromyotomy needed morehospital stay ( Mean 2.9 days ) till achievement of full feeding than laparoscopic pyloromyotomy ( mean 1.7 days ).Through the study, we addressed cosmetic results according to patient’s parent or guardian satisfaction to cosmeticresults. 4 cases’ (20% of the total group) Parents in group A complained of the shape of the scar and wished if itwas better (Shown in the next picture), while parents in Group B was satisfied with the post operative scar whichwas mostly unnoticed.Conclusion: The study revealed that laparoscopic pyloromyotomy has excellent cosmesis, less hospital stay,with operative time and complications comparable rates to open approach, so it can be considered as a standardtechnique for treatment of IHPS.