Annals of the Royal College of Surgeons of England · 2026
A prospective randomised controlled trial comparing open and laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis in a low-middle-income country setting.
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Ahmad S, Talat N, Rehan M, Saleem M S, Mahmood U
Аннотация
INTRODUCTION: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of non-bilious projectile vomiting in early infancy. Although open pyloromyotomy (OPM) remains the standard in many low-middle-income countries (LMICs), laparoscopic pyloromyotomy (LPM) is increasingly favoured in high-income settings for its faster recovery and improved cosmesis. This study compares the feasibility, safety and outcomes of OPM and LPM at Pakistan's largest public paediatric hospital.
METHODS: This randomised trial enrolled 60 infants with IHPS allocated to open (OPM, n = 30) or laparoscopic pyloromyotomy (LPM, n = 30). Operative time was measured skin-to-skin, with secondary analysis of pyloromyotomy time. Primary outcomes were operative duration, time to full feeding and postoperative stay.
RESULTS: Total operative time was shorter for OPM (39.3 ± 9.5 vs 56.9 ± 31.2min, p < 0.05). Pyloromyotomy time was also shorter in OPM (29.1 ± 8.2 vs 49.3 ± 32.7min, p < 0.05). However, LPM patients achieved full feeding faster (7.1 ± 1.5 vs 11.2 ± 9.8h, p < 0.05) and had shorter hospital stays (1.4 ± 0.7 vs 2.5 ± 1.9 days, p < 0.05). Complication rates were comparable.
CONCLUSIONS: Despite longer operative times, LPM demonstrated significantly better postoperative recovery. With appropriate training and investment, LPM is a feasible and beneficial alternative to OPM in LMIC settings.
METHODS: This randomised trial enrolled 60 infants with IHPS allocated to open (OPM, n = 30) or laparoscopic pyloromyotomy (LPM, n = 30). Operative time was measured skin-to-skin, with secondary analysis of pyloromyotomy time. Primary outcomes were operative duration, time to full feeding and postoperative stay.
RESULTS: Total operative time was shorter for OPM (39.3 ± 9.5 vs 56.9 ± 31.2min, p < 0.05). Pyloromyotomy time was also shorter in OPM (29.1 ± 8.2 vs 49.3 ± 32.7min, p < 0.05). However, LPM patients achieved full feeding faster (7.1 ± 1.5 vs 11.2 ± 9.8h, p < 0.05) and had shorter hospital stays (1.4 ± 0.7 vs 2.5 ± 1.9 days, p < 0.05). Complication rates were comparable.
CONCLUSIONS: Despite longer operative times, LPM demonstrated significantly better postoperative recovery. With appropriate training and investment, LPM is a feasible and beneficial alternative to OPM in LMIC settings.