Trends and surgical outcomes of laparoscopic versus open pyloromyotomy

Trends and surgical outcomes of laparoscopic versus open pyloromyotomy Background Hypertrophic pyloric stenosis (HPS) is one of the most common pediatric illnesses necessitating surgical intervention. Controversy remains over the optimal surgical approach between laparoscopic pyloromyotomy (LP) and open pyloromyotomy (OP). LP has gained acceptance for management of HPS in an era of expanding minimal access surgical approaches to pediatric conditions. Several studies suggest advantages of LP over OP; however, selection bias and small sample sizes remain a concern. This study compares the outcomes of LP versus OP using propensity score methods. Methods The 2013–2015 ACS NSQIP Pediatric PUF was queried for all infants undergoing pyloromyotomy. The trend in the proportion of infants undergoing LP was described and perioperative outcomes between the OP and LP cohorts were compared using propensity score weighted regression models. Results 4847 infants were identified to have undergone surgical pyloromyotomy. The proportion of LP performed increased significantly from 59% in 2013 to 65.5% in 2015 (p < 0.001). LP was associated with lower overall complications (1.4% vs 2.9%) (OR  0.52, 95% CI 0.34–0.80), surgical site-related complications (1.1% vs 2.1%) (OR  0.52, 95% CI 0.32–0.84), and adj adj post-operative length of stay (1.5 days vs 1.9 days) (OR  0.89, 95% CI 0.81–0.98) without significant differences in related adj http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Surgical Endoscopy Springer Journals

Trends and surgical outcomes of laparoscopic versus open pyloromyotomy

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Publisher
Springer US
Copyright
Copyright © 2018 by Springer Science+Business Media, LLC, part of Springer Nature
Subject
Medicine & Public Health; Surgery; Gynecology; Gastroenterology; Hepatology; Proctology; Abdominal Surgery
ISSN
0930-2794
eISSN
1432-2218
D.O.I.
10.1007/s00464-018-6060-0
Publisher site
See Article on Publisher Site

Abstract

Background Hypertrophic pyloric stenosis (HPS) is one of the most common pediatric illnesses necessitating surgical intervention. Controversy remains over the optimal surgical approach between laparoscopic pyloromyotomy (LP) and open pyloromyotomy (OP). LP has gained acceptance for management of HPS in an era of expanding minimal access surgical approaches to pediatric conditions. Several studies suggest advantages of LP over OP; however, selection bias and small sample sizes remain a concern. This study compares the outcomes of LP versus OP using propensity score methods. Methods The 2013–2015 ACS NSQIP Pediatric PUF was queried for all infants undergoing pyloromyotomy. The trend in the proportion of infants undergoing LP was described and perioperative outcomes between the OP and LP cohorts were compared using propensity score weighted regression models. Results 4847 infants were identified to have undergone surgical pyloromyotomy. The proportion of LP performed increased significantly from 59% in 2013 to 65.5% in 2015 (p < 0.001). LP was associated with lower overall complications (1.4% vs 2.9%) (OR  0.52, 95% CI 0.34–0.80), surgical site-related complications (1.1% vs 2.1%) (OR  0.52, 95% CI 0.32–0.84), and adj adj post-operative length of stay (1.5 days vs 1.9 days) (OR  0.89, 95% CI 0.81–0.98) without significant differences in related adj

Journal

Surgical EndoscopySpringer Journals

Published: Jan 16, 2018

References

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