Laparoscopic pyloromyotomy decreases postoperative length of stay in children with hypertrophic pyloric stenosis.

OBJECTIVE

To determine the impact of laparoscopic versus open pyloromyotomy on postoperative length of stay (LOS).

MATERIALS AND

METHODS

The 2013 National Surgical Quality Improvement Project Pediatric database was queried for all cases of pyloromyotomy performed on children <1year old with congenital hypertrophic pyloric stenosis. Demographics, clinical, and perioperative characteristics for patients with and without a prolonged postoperative LOS, defined as >1day, were compared. Logistic regression modeling was performed to identify factors associated with a prolonged postoperative LOS.

RESULTS

Out of 1143 pyloromyotomy patients, 674 (59%) underwent a laparoscopic procedure. Patients undergoing open pyloromyotomy had a longer operative time (median 28 vs. 25min, p<0.001) but shorter duration of general anesthesia (median 72 vs. 78min, p<0.001). Patients undergoing open pyloromyotomy more frequently had a prolonged postoperative LOS (32% vs. 26%, p=0.019). Factors independently associated with postoperative LOS >1day included open pyloromyotomy (odds ratio, 95% confidence interval, p-value) (1.38, 1.03-1.84, p=0.030), cardiac comorbidity (3.64, 1.45-9.14, p=0.006), pulmonary comorbidity (3.47, 1.15-10.46, p=0.027), lower weight (1.005 per 100g decrease, 1.002-1.007, p<0.001), longer preoperative LOS (1.35 per additional day, 1.13-1.62, p=0.001), longer operative time (1.11 per additional 5min, 1.05-1.17, p<0.001), higher preoperative blood urea nitrogen (1.04 per additional mg/dl, 1.01-1.07, p=0.012), and higher serum sodium (1.08 per additional mg/dl, 1.03-1.14, p=0.004).

CONCLUSIONS

Compared to laparoscopic pyloromyotomy, open pyloromyotomy is independently associated with a higher likelihood of a prolonged postoperative LOS.