A prospective randomised controlled trial comparing open and laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis in a low–middle-income country setting
S Ahmad, N Talat, M Rehan, MS Saleem, U MahmoodIntroduction
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.