Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA, 94305, USA.
Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Surg Endosc. 2018 Jul;32(7):3380-3385. doi: 10.1007/s00464-018-6060-0. Epub 2018 Jan 16.
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.
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.
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 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 re-operation (0.9% vs 0.9%) (OR 1.01, 95% CI 0.52-1.93) or readmissions (1.4% vs 2.1%) (OR 0.73, 95% CI 0.46-1.17).
Our study demonstrates that LP is increasingly utilized for management of hypertrophic pyloric stenosis and is associated with shorter length of stay, and lower odds of surgical site-specific and overall complications without differences in related re-operations. This study supports LP as a safe and effective method for management of HPS.
肥厚性幽门狭窄（HPS）是最常见的需要手术干预的儿科疾病之一。腹腔镜幽门肌切开术（LP）和开腹幽门肌切开术（OP）之间的最佳手术方法仍存在争议。在微创外科方法广泛应用于儿科疾病的时代，LP 已被接受用于治疗 HPS。几项研究表明 LP 优于 OP；然而，选择偏倚和样本量小仍然是一个问题。本研究使用倾向评分方法比较 LP 与 OP 的结果。
2013-2015 年 ACS NSQIP 儿科 PUF 对所有接受幽门肌切开术的婴儿进行了查询。描述了 LP 婴儿比例的趋势，并使用倾向评分加权回归模型比较了 OP 和 LP 队列的围手术期结果。
共确定 4847 例婴儿接受了外科幽门肌切开术。LP 的比例从 2013 年的 59%显著增加到 2015 年的 65.5%（p<0.001）。LP 与总并发症发生率较低相关（1.4%比 2.9%）（OR 0.52，95%CI 0.34-0.80），手术部位相关并发症发生率较低（1.1%比 2.1%）（OR 0.52，95%CI 0.32-0.84），术后住院时间较短（1.5 天比 1.9 天）（OR 0.89，95%CI 0.81-0.98），但相关再手术率（0.9%比 0.9%）（OR 1.01，95%CI 0.52-1.93）或再入院率（1.4%比 2.1%）（OR 0.73，95%CI 0.46-1.17）无显著差异。
我们的研究表明，LP 越来越多地用于治疗肥厚性幽门狭窄，与较短的住院时间和较低的手术部位特定和总并发症发生率相关，而相关再手术率无差异。本研究支持 LP 作为治疗 HPS 的一种安全有效的方法。
