COMPARISON OF OUTCOMES OF OPEN VS. LAPAROSCOPIC SURGERY FOR INFANTILE HYPERTROPHIC PYLORIC STENOSIS

Abstract

Background: Infantile Hypertrophic Pyloric Stenosis (IHPS) is a common surgical condition in infants characterized by pyloric muscle hypertrophy leading to gastric outlet obstruction. While laparoscopic pyloromyotomy has gained popularity, concerns remain regarding its safety compared to the traditional open approach, particularly regarding mucosal perforation and incomplete myotomy.

Objective: To compare the outcomes of open versus laparoscopic pyloromyotomy in infants with IHPS, focusing on time to full feeding, postoperative complications, length of hospital stay, and overall safety.

Methods: This prospective, non-randomized controlled trial was conducted at the Department of Pediatric Surgery, Khyber Teaching Hospital, Peshawar, from January to June 2023. A total of 112 infants aged 3 to 12 weeks with confirmed IHPS were enrolled using consecutive sampling and allocated to either open pyloromyotomy (Group A, n=56) or laparoscopic pyloromyotomy (Group B, n=56). Diagnosis was confirmed by ultrasound (pyloric thickness ≥4 mm, channel length ≥14 mm) and clinical features. Primary outcomes included time to full enteral feeding, postoperative complications (wound infection, mucosal perforation, incomplete pyloromyotomy, reoperation), and hospital stay. Data were analyzed using SPSS version 25, employing independent t-tests for continuous variables and chi-square tests for categorical variables, with significance set at p<0.05.

Results: Baseline characteristics were comparable between groups. The laparoscopic group achieved full feeding significantly faster (15.29 ± 2.71 hours) versus the open group (17.33 ± 3.69 hours; p=0.0012). Hospital stay was significantly shorter in the laparoscopic group (2.52 ± 0.48 days) compared to the open group (2.97 ± 0.45 days; p<0.0001). Overall complications occurred in 11 patients (19.1%) in the open group and 6 patients (10.5%) in the laparoscopic group, with no statistically significant difference (p=0.0926). Specific complications including wound infection (5.4% vs. 1.8%, p=0.309), mucosal perforation (3.6% vs. 3.6%, p=1.000), incomplete pyloromyotomy (7.1% vs. 3.6%, p=0.401), and reoperation (3.6% vs. 1.8%, p=0.558) showed no significant differences between groups.

Conclusion: Laparoscopic pyloromyotomy offers significant advantages over open pyloromyotomy, including faster recovery with earlier full feeding and shorter hospital stays, while maintaining a comparable safety profile. These findings support laparoscopic pyloromyotomy as the preferred surgical approach for IHPS when appropriate expertise and resources are available. Larger randomized controlled trials with extended follow-up are recommended to confirm these findings.