Trainee involvement in laparoscopic pyloromyotomy does not compromise outcomes: evidence from a longitudinal institutional experience.

PURPOSE: To evaluate whether supervised pediatric surgery trainees can safely perform laparoscopic pyloromyotomy (LP) and to assess the influence of trainee participation within the institutional learning curve.

METHODS

A retrospective single-center cohort included all infants undergoing LP between June 2011-2025. Cases were categorized as specialist- or trainee-performed (eight pediatric surgery specialists, three supervised trainees). Baseline characteristics, operative variables, surgery-related complications, incomplete pyloromyotomy, postoperative recovery, reintervention, and readmission were compared. Temporal trends and institutional CUSUM analysis were performed.

RESULTS

Seventy-seven infants were included (45 specialist-operated, 32 trainee-operated). Baseline characteristics were similar. Operative time was longer for trainees (45 versus 40 min, p = 0.037). Surgery-related complications occurred in 11.1% of specialist cases and in none of the trainee cases (p=0.07). All five complications (two wound infections, one incisional omental exteriorization, and two mucosal perforations) occurred with specialists. One incomplete pyloromyotomy occurred (trainees). The composite adverse outcome rate was 11.1% (specialists) versus 3.1% (trainees) (p = 0.39). Feeding progression, length of stay, reoperations and readmissions were comparable. CUSUM analysis demonstrated no adverse drift after trainee integration.

CONCLUSION

Supervised trainees safely performed LP with outcomes comparable to specialists. Slightly longer operative time did not impact recovery. Early trainee involvement did not compromise patient safety or institutional performance.