Comparison of postoperative recovery after laparoscopic and open pyloromyotomy

Background and Purpose: Although laparoscopic pyloromyotomy offers a cosmetic advantage over the open approach, its effect on postoperative recovery, particularly the tolerance for feedings, is less clear. We compared the postoperative courses of infants who underwent laparoscopic and open pyloromyotomy. Patients and Methods: The records of 62 consecutive infants who underwent pyloromyotomy (34 laparoscopic, 28 open) were retrospectively reviewed. Feedings were offered at 1 hour postoperatively and advanced to goal volume by 7 hours if tolerated. Information relating to the duration of symptoms, time to reach goal feedings, length of stay, and demographics was collected. The mean age, weight, and duration of preoperative emesis were similar in the two groups. Results: After laparoscopic pyloromyotomy, 15 of 34 patients (44%) tolerated full-volume feeding within 12 hours v 7 of 28 (25%) of those who underwent open pyloromyotomy (P = NS; X² analysis). The mean time to tolerance of full-volume feedings was 18.5 hours in the laparoscopic group and 21.2 hours in the open surgery group (P = NS; t-test). Total length of stay was 48.3 hours for the laparoscopic group and 52.5 hours for the open surgery group (P = NS). Conclusion: We were unable to demonstrate a significant improvement in the tolerance for postoperative feedings or length of stay with laparoscopic pyloromyotomy compared with the open approach. Although laparoscopic pyloromyotomy yields a superior cosmetic result, postoperative recovery may not be improved.