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Risk of incomplete pyloromyotomy and mucosal perforation in open and laparoscopic pyloromyotomy

Risk of incomplete pyloromyotomy and mucosal perforation in open and laparoscopic pyloromyotomy
Risk of incomplete pyloromyotomy and mucosal perforation in open and laparoscopic pyloromyotomy
Background

Despite randomized controlled trials and meta-analyses, it remains unclear whether laparoscopic pyloromyotomy (LP) carries a higher risk of incomplete pyloromyotomy and mucosal perforation compared with open pyloromyotomy (OP).

Methods

Multicenter study of all pyloromyotomies (May 2007–December 2010) at nine high-volume institutions. The effect of laparoscopy on the procedure-related complications of incomplete pyloromyotomy and mucosal perforation was determined using binomial logistic regression adjusting for differences among centers.

Results

Data relating to 2830 pyloromyotomies (1802 [64%] LP) were analyzed. There were 24 cases of incomplete pyloromyotomy; 3 in the open group (0.29%) and 21 in the laparoscopic group (1.16%). There were 18 cases of mucosal perforation; 3 in the open group (0.29%) and 15 in the laparoscopic group (0.83%). The regression model demonstrated that LP was a marginally significant predictor of incomplete pyloromyotomy (adjusted difference 0.87% [95% CI 0.006–4.083]; P = 0.046) but not of mucosal perforation (adjusted difference 0.56% [95% CI ? 0.096 to 3.365]; P = 0.153). Trainees performed a similar proportion of each procedure (laparoscopic 82.6% vs. open 80.3%; P = 0.2) and grade of primary operator did not affect the rate of either complication.

Conclusions

This is one of the largest series of pyloromyotomy ever reported. Although laparoscopy is associated with a statistically significant increase in the risk of incomplete pyloromyotomy, the effect size is small and of questionable clinical relevance. Both OP and LP are associated with low rates of mucosal perforation and incomplete pyloromyotomy in specialist centers, whether trainee or consultant surgeons perform the procedure.
pyloric stenosis, pyloromyotomy, minimally invasive surgery, infant
0022-3468
1083-1086
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Eaton, Simon
e14103c2-c06a-45e6-87fe-2358a3371283
Seims, Aaron
0f2365ce-487b-4abd-b275-f527992ac7d7
Leys, Charles M.
eca20ab0-e798-4265-abf2-80b8ce0fdd88
Densmore, John C.
6863fbdc-036a-439d-9762-ed88b178deeb
Calkins, Casey M.
5d887220-f571-45df-9af7-f9f5ce3aae84
Ostlie, Daniel J.
39720de6-17d0-459c-ae4a-2e1a66f44722
St Peter, Shawn D.
59589bcf-de51-44c5-9889-91299e2c2b6b
Azizkhan, Richard G.
d40ba220-c83e-4f49-aab6-b1c7fd4300d8
von Allmen, Daniel
654dafb9-ab3b-41c6-b24f-666c0caac6c3
Langer, Jacob C.
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Lapidus-Krol, Eveline
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Bouchard, Sarah
77e75724-1f0d-4e96-b96d-d4ee4db74c34
Piché, Nelson
3ab693be-f6b8-42b1-829b-9d0865262124
Bruch, Steven
baf3c26e-ce4e-45f0-afbc-84e2b8f1f75a
Drongowski, Robert
f2120089-dd76-459c-bd26-12015ab24d43
MacKinlay, Gordon A.
158ff169-e5a6-4d40-b8f8-79331babdfa7
Clark, Claire
cd5462e1-216a-4dee-b7a5-114aa06c5f48
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Eaton, Simon
e14103c2-c06a-45e6-87fe-2358a3371283
Seims, Aaron
0f2365ce-487b-4abd-b275-f527992ac7d7
Leys, Charles M.
eca20ab0-e798-4265-abf2-80b8ce0fdd88
Densmore, John C.
6863fbdc-036a-439d-9762-ed88b178deeb
Calkins, Casey M.
5d887220-f571-45df-9af7-f9f5ce3aae84
Ostlie, Daniel J.
39720de6-17d0-459c-ae4a-2e1a66f44722
St Peter, Shawn D.
59589bcf-de51-44c5-9889-91299e2c2b6b
Azizkhan, Richard G.
d40ba220-c83e-4f49-aab6-b1c7fd4300d8
von Allmen, Daniel
654dafb9-ab3b-41c6-b24f-666c0caac6c3
Langer, Jacob C.
f2b7aeb2-f1a8-4475-b4e8-1a8e31eb1923
Lapidus-Krol, Eveline
35c734f4-de58-4047-8f4d-348cea5b5b39
Bouchard, Sarah
77e75724-1f0d-4e96-b96d-d4ee4db74c34
Piché, Nelson
3ab693be-f6b8-42b1-829b-9d0865262124
Bruch, Steven
baf3c26e-ce4e-45f0-afbc-84e2b8f1f75a
Drongowski, Robert
f2120089-dd76-459c-bd26-12015ab24d43
MacKinlay, Gordon A.
158ff169-e5a6-4d40-b8f8-79331babdfa7
Clark, Claire
cd5462e1-216a-4dee-b7a5-114aa06c5f48
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997

Hall, Nigel J., Eaton, Simon, Seims, Aaron, Leys, Charles M., Densmore, John C., Calkins, Casey M., Ostlie, Daniel J., St Peter, Shawn D., Azizkhan, Richard G., von Allmen, Daniel, Langer, Jacob C., Lapidus-Krol, Eveline, Bouchard, Sarah, Piché, Nelson, Bruch, Steven, Drongowski, Robert, MacKinlay, Gordon A., Clark, Claire and Pierro, Agostino (2014) Risk of incomplete pyloromyotomy and mucosal perforation in open and laparoscopic pyloromyotomy. Journal of Pediatric Surgery, 49 (7), 1083-1086. (doi:10.1016/j.jpedsurg.2013.10.014). (PMID:24952793)

Record type: Article

Abstract

Background

Despite randomized controlled trials and meta-analyses, it remains unclear whether laparoscopic pyloromyotomy (LP) carries a higher risk of incomplete pyloromyotomy and mucosal perforation compared with open pyloromyotomy (OP).

Methods

Multicenter study of all pyloromyotomies (May 2007–December 2010) at nine high-volume institutions. The effect of laparoscopy on the procedure-related complications of incomplete pyloromyotomy and mucosal perforation was determined using binomial logistic regression adjusting for differences among centers.

Results

Data relating to 2830 pyloromyotomies (1802 [64%] LP) were analyzed. There were 24 cases of incomplete pyloromyotomy; 3 in the open group (0.29%) and 21 in the laparoscopic group (1.16%). There were 18 cases of mucosal perforation; 3 in the open group (0.29%) and 15 in the laparoscopic group (0.83%). The regression model demonstrated that LP was a marginally significant predictor of incomplete pyloromyotomy (adjusted difference 0.87% [95% CI 0.006–4.083]; P = 0.046) but not of mucosal perforation (adjusted difference 0.56% [95% CI ? 0.096 to 3.365]; P = 0.153). Trainees performed a similar proportion of each procedure (laparoscopic 82.6% vs. open 80.3%; P = 0.2) and grade of primary operator did not affect the rate of either complication.

Conclusions

This is one of the largest series of pyloromyotomy ever reported. Although laparoscopy is associated with a statistically significant increase in the risk of incomplete pyloromyotomy, the effect size is small and of questionable clinical relevance. Both OP and LP are associated with low rates of mucosal perforation and incomplete pyloromyotomy in specialist centers, whether trainee or consultant surgeons perform the procedure.

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More information

Published date: July 2014
Additional Information: Accepted 7 October 2013
Keywords: pyloric stenosis, pyloromyotomy, minimally invasive surgery, infant
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 375548
URI: http://eprints.soton.ac.uk/id/eprint/375548
ISSN: 0022-3468
PURE UUID: 92b147a1-1689-4d71-94af-32f668b5f344
ORCID for Nigel J. Hall: ORCID iD orcid.org/0000-0001-8570-9374

Catalogue record

Date deposited: 30 Mar 2015 11:07
Last modified: 15 Mar 2024 03:38

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Contributors

Author: Nigel J. Hall ORCID iD
Author: Simon Eaton
Author: Aaron Seims
Author: Charles M. Leys
Author: John C. Densmore
Author: Casey M. Calkins
Author: Daniel J. Ostlie
Author: Shawn D. St Peter
Author: Richard G. Azizkhan
Author: Daniel von Allmen
Author: Jacob C. Langer
Author: Eveline Lapidus-Krol
Author: Sarah Bouchard
Author: Nelson Piché
Author: Steven Bruch
Author: Robert Drongowski
Author: Gordon A. MacKinlay
Author: Claire Clark
Author: Agostino Pierro

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