Paediatric surgery.Ukraine.2021.4(73):53-58; doi 10.15574/PS.2021.73.53
Pereyaslov A. A.¹, Malovanyy B. Y.², Stenyk R. V.², Dvorakevych A. O.², Mykyta M. M.^2
1Danylo Halytsky Lviv national medical university, Ukraine
²CNE of Lviv Regional Council «Lviv Regional Children’s Clinical Hospital «OHMATDYT», Ukraine

For citation: Pereyaslov AA, Malovanyy BY, Stenyk RV, Dvorakevych AO, Mykyta MM. (2021). Choice of method of the treatment in newborns with hypertrophic pyloric stenosis. Paediatric Surgery.Ukraine. 4(73):53-58; doi 10.15574/PS.2021.73.53.
Article received: Aug 02, 2021. Accepted for publication: Dec 08, 2021.

Hypertrophic pyloric stenosis (HPS) remains the main cause of projectile vomiting in newborns. During many decades the open pyloromyotomy was the main method of treatment in children with HPS due to the excellent results and low frequency of complications. After applying the laparoscopic pyloromyotomy, this approach gradually became accepted by pediatric surgeons. Regarding advantages and disadvantages of laparoscopic pyloromyotomy compared to conventional pyloromyotomy the literature data had a contradictory character.
The aim is to analyze our own experience in the treatment of children with HPS using traditional and minimally invasive techniques.
Materials and methods. This study based on the results of the treatment of 98 children, which were operated with pyloric stenosis during 2009–2020 years. Diagnosis was established on the results of clinical, laboratory investigation, and ultrasonographic data. Surgery was applied after correction of electrolytes disturbances, but a type of approach (open or laparoscopic) was chosen by surgeon. With the aim to evaluate the results the methods of variative statistic, parametric and nonparametric evaluation were applied.
Results. Open pyloromyotomy was applied in 76 (77.6%) and laparoscopic – in 22 (22.4%) of children. Complications developed in 10 children, including 8 (10.5%) patients after open and 2 (9.1%) – after laparoscopic pyloromyotomy (p=0.842). Perforation of mucosa was in one (4.55%) child during laparoscopic pyloromyotomy, but in case of open approach this complication was absent. Independence of the approach, the cases of incomplete myotomy were absent. The surgical site infection (3.95%), postoperative hernia (2.63%), and adhesive bowel obstruction (2.63%) were more often observed after open pyloromyotomy. Laparoscopic pyloromyotomy characterized by the decrease of terms of starting enteral feeding (p<0.001) and length of hospital stay (p=0.031) compared with open pyloromyotomy.
Conclusions. Pyloromyotomy remains the main method of treatment of newborns with pyloric stenosis, but a type of approach was chosen by surgeon. Open and laparoscopic pyloromyotomy equally effective and safe for the treatment of children with the hypertrophic pyloric stenosis.
The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
Key words: hypertrophic pyloric stenosis, newborns, treatment, pyloromyotomy, laparoscopy.

REFERENCES

1. Adibe OO, Nichol PF, Flake AW et al. (2006). Comparison of outcomes after laparoscopic and open pyloromyotomy at a high-volume pediatric teaching hospital. J Pediatr Surg. 41 (10): 1676-1678. https://doi.org/10.1016/j.jpedsurg.2006.05.051; PMid:17011267

2. Alain JL, Grousseau D, Terrier G. (1991). Extramucosal pyloromyotomy by laparoscopy. Surg Endosc. 5 (4): 174-175. https://doi.org/10.1007/BF02653256; PMid:1839574

3. Anderson SA, Beierle EA, Chen MK. (2014). Role of laparoscopy in the prevention and in the treatment of adhesions. Semin Pediatr Surg. 23 (6): 353-356. https://doi.org/10.1053/j.sempedsurg.2014.06.007; PMid:25459441

4. Bensard DD, Hendrickson RJ, Clark KS et al. (2010). Use of ultrasound measurements to direct laparoscopic pyloromyotomy in infants. JSLS. 14 (4): 553-557. https://doi.org/10.4293/108680810X12924466008321; PMid:21605521 PMCid:PMC3083048

5. Binet A, Bastard F, Meignan P et al. (2018). Laparoscopic pyloromyotomy: A study of the learning curve. Eur J Pediatr Surg. 28 (3): 238-242. https://doi.org/10.1055/s-0037-1603090; PMid:28505691

6. Binet A, Klipfel C, Meignan P et al. (2018). Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a survey of 407 children. Pediatr Surg Int. 34 (4): 421-426. https://doi.org/10.1007/s00383-018-4235-3; PMid:29411105

7. Bodnar BM, Zavolovych AY, Ahtemiichuk YuT. (2006). Tacticosurgical aspects of congenital pylorostenosis. Pediatric Surgery. 3 (1): 25-29.

8. Caceres M, Liu D. (2003). Laparoscopic pyloromyotomy: redefining the advantages of a novel technique. JSLS. 7 (2): 123-127.

9. Carrington EV, Hall NJ, Pacilli M et al. (2012). Cost effectiveness of laparoscopic versus open pyloromyotomy. J Surg Res. 178 (1): 315-320. https://doi.org/10.1016/j.jss.2012.01.031; PMid:22480835

10. Chiarenza SF, Bleve C, Escolino M et al. (2020). Guidelines of the Italian Society of Videosurgery (SIVI) in infancy for the minimally invasive treatment of hypertrophic pyloric stenosis in neonates and infants. Pediatr Med Chir. 42 (1): 16-24. https://doi.org/10.4081/pmc.2020.243

11. Clayton JT, Reisch JS, Sanchez PJ et al. (2015). Postoperative regimentation of treatment optimizes care and optimizes length of stay (PROTOCOL) after pyloromyotomy. J Pediatr Surg. 50 (9): 1540-1543. https://doi.org/10.1016/j.jpedsurg.2014.12.019; PMid:25783325

12. Cosper GH, Menon R, Hamann MS, Nakayama DK. (2008). Residency training in pyloromyotomy: a survey of 331 pediatric surgeons. J Pediatr Surg. 43 (1): 102-108. https://doi.org/10.1016/j.jpedsurg.2007.09.029; PMid:18206465

13. Costanzo CM, Vinocur C, Berman L. (2018). Postoperative outcomes of open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis. J Surg Res. 224: 240-244. https://doi.org/10.1016/j.jss.2017.08.040; PMid:29506847

14. Donda K, Asare-Afriyie B, Ayensu M et al. (2019). Pyloric stenosis: national trends in the incidence rate and resource use in the United States from 2012 to 2016. Hosp Pediatr. 9 (12): 923-932. https://doi.org/10.1542/hpeds.2019-0112; PMid:31748239

15. Ein SH, Masiakos PT, Ein A. (2014). The ins and outs of pyloromyotomy: what we have learned in 35 years. Pediatr Surg Int. 30 (5): 467-480. https://doi.org/10.1007/s00383-014-3488-8; PMid:24626877

16. El Gohary Y, Abdelhafeez A, Paton E et al. (2018). Pyloric stenosis: an enigma more than a century after the first successful treatment. Pediatr Surg Int. 34 (1): 21-27. https://doi.org/10.1007/s00383-017-4196-y; PMid:29030700

17. Fan J, Shi Y, Cheng M et al. (2016). Treating idiopathic hypertrophic pyloric stenosis with sequential therapy: a clinical study. J Paediatr Child Health. 52 (7): 734-738. https://doi.org/10.1111/jpc.13184; PMid:27439633

18. Hall NJ, Ade-Ajayi N, Al-Roubaie J et al. (2004). Retrospective comparison of open versus laparoscopic pyloromyotomy. Br J Surg. 91 (10): 1325-1329. https://doi.org/10.1002/bjs.4523; PMid:15376185

19. Hall NJ, Eaton S, Seims A et al. (2014). Risk of incomplete pyloromyotomy and mucosal perforation in open and laparoscopic pyloromyotomy. J Pediatr Surg. 49 (7): 1083-1086. https://doi.org/10.1016/j.jpedsurg.2013.10.014; PMid:24952793

20. Hall NJ, Pacilli M, Eaton S et al. (2009). Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet. 373 (9661): 390-398. https://doi.org/10.1016/S0140-6736(09)60006-4

21. Henderson L, Hussein N, Patwardhan N, Dagash H. (2018). Outcomes during a transition period from open to laparoscopic pyloromyotomy. J Laparoendosc Adv Surg Tech A. 28 (4): 481-485. https://doi.org/10.1089/lap.2017.0366; PMid:29265912

22. Huang WH, Zhang QL, Chen L et al. (2020). The safety and effectiveness of laparoscopic versus open surgery for congenital hypertrophic pyloric stenosis in infants. Med Sci Monit. 26: e921555. https://doi.org/10.12659/MSM.921555

23. Hukeri A, Gupta A, Kothari P et al. (2019). Our experience of laparoscopic pyloromyotomy with ultrasound-guided parameters. J Minim Access Surg. 15 (1): 51-55. https://doi.org/10.4103/jmas.JMAS_193_17; PMid:29582798 PMCid:PMC6293670

24. Ismail I, Elsherbini R, Elsaied A et al. (2020). Laparoscopic vs. open pyloromyotomy in treatment of infantile hypertrophic pyloric stenosis. Front Pediatr. 8: 426. https://doi.org/10.3389/fped.2020.00426; PMid:32984197 PMCid:PMC7475708

25. Jia WQ, Tian JH, Yang KH et al. (2011). Open versus laparoscopic pyloromyotomy for pyloric stenosis: a meta-analysis of randomized controlled trials. Eur J Pediatr Surg. 21 (2): 77-81. https://doi.org/10.1055/s-0030-1261926; PMid:20957601

26. Jobson M, Hall NJ. (2016). Contemporary management of pyloric stenosis. Semin Pediatr Surg. 25 (4): 219-224. https://doi.org/10.1053/j.sempedsurg.2016.05.004; PMid:27521712

27. Kelay A, Hall NJ. (2018). Perioperative complications of surgery for hypertrophic pyloric stenosis. Eur J Pediatr Surg. 28 (2): 171-175. https://doi.org/10.1055/s-0038-1637016; PMid:29510427

28. Kethman WC, Harris AHS, Hawn MT, Wall JK. (2018). Trends and surgical outcomes of laparoscopic versus open pyloromyotomy. Surg Endosc. 32 (7): 3380-3385. https://doi.org/10.1007/s00464-018-6060-0; PMid:29340829 PMCid:PMC6383511

29. Kozlov Y, Kovalkov K, Smirnov A. (2019). Gastric peroral endoscopic myotomy for treatment of congenital pyloric stenosis – first clinical experience. J Laparoendosc Adv Surg Tech A. 29 (6): 860-864. https://doi.org/10.1089/lap.2018.0803; PMid:31017541

30. Lauriti G, Cascini V, Chiesa PL et al. (2018). Atropine treatment for hypertrophic pyloric stenosis: a systematic review and meta-analysis. Eur J Pediatr Surg. 28 (5): 393-399. https://doi.org/10.1055/s-0037-1604116; PMid:28701002

31. Leclair MD, Plattner V, Mirallie E et al. (2007). Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a prospective, randomized controlled trial. J Pediatr Surg. 42 (4): 692-698. https://doi.org/10.1016/j.jpedsurg.2006.12.016; PMid:17448768

32. Liu ZQ, Li QL, Liu JB et al. (2020). Peroral pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis. Endoscopy. 52 (4): E122-E123. https://doi.org/10.1055/a-1022-4274; PMid:31652470

33. Nagita A, Yamaguchi J, Amemoto K et al. (1996). Management and ultrasonographic appearance of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate. J Pediatr Gastroenterol Nutr. 23 (2): 172-177. https://doi.org/10.1097/00005176-199608000-00013; PMid:8856585

34. Pogorelić Z, Zelić A, Jukić M, Llorente Munoz CM. (2021). The safety and effectiveness of laparoscopic pyloromyotomy using 3-mm electrocautery hook versus open surgery for treatment of hypertrophic pyloric stenosis in infants. Children (Basel). 8 (8): 701. https://doi.org/10.3390/children8080701; PMid:34438592 PMCid:PMC8392573

35. Ramstedt C. (1912). Zur Ooperation der angeborenen Pylorusstenose. Med Klin. 26: 1191-1192. 

36. Safford SD, Pietrobon R, Safford KM et al. (2005). A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes. J Pediatr Surg. 40 (6): 967-972. https://doi.org/10.1016/j.jpedsurg.2005.03.011; PMid:15991179

37. Siddiqui S, Heidel RE, Angel CA, Kennedy AP Jr. (2012). Pyloromyotomy: randomized control trial of laparoscopic vs open technique. J Pediatr Surg. 47 (1): 93-98. https://doi.org/10.1016/j.jpedsurg.2011.10.026; PMid:22244399

38. Sola JE, Neville HL. (2009). Laparoscopic vs open pyloromyotomy: a systematic review and meta analysis. J Pediatr Surg. 44 (8): 1631-1637. https://doi.org/10.1016/j.jpedsurg.2009.04.001; PMid:19635317

39. Spahi OV, Tokarev BG, Ljaturinskaja OV, Zaporozhenko AG. (2004). The immediate and remote results of treatment of congenital pylorostenosis at children. Pediatric Surgery. 4 (3): 63-69.

40. Spakhi OV. (2015). Diagnostic peculiarities of congenital hypertrophic pyloric stenosis in children today. Neonatology, surgery and perinatal medicine. 5 (3): 72-74. https://doi.org/10.24061/2413-4260.V.3.17.2015.12

41. St Peter SD, Holcomb GW, Calkins CM et al. (2006). Open versus laparoscopic pyloromyotomy for pyloric stenosis: A prospective, randomized trial. Ann Surg. 244 (3): 363-370. https://doi.org/10.1097/01.sla.0000234647.03466.27; PMid:16926562 PMCid:PMC1856534

42. Staerkle RF, Lunger F, Fink L еt al. (2021). Open versus laparoscopic pyloromyotomy for pyloric stenosis. Cochrane Database Syst Rev. 3 (3): CD012827. https://doi.org/10.1002/14651858.CD012827.pub2; PMid:33686649

43. van den Bunder FAIM, van Woensel JBM, Stevens MF et al. (2020). Respiratory problems owing to severe metabolic alkalosis in infants presenting with hypertrophic pyloric stenosis. J Pediatr Surg. 55 (12): 2772-2776. https://doi.org/10.1016/j.jpedsurg.2020.05.041; PMid:32641249

44. van der Bilt JD, Kramer WL, van der Zee DC, Bax NM. (2004). Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: impact of experience on the results in 182 cases. Surg Endosc. 18 (6): 907-909. https://doi.org/10.1007/s00464-003-9075-z; PMid:15108114

45. Vinycomb TI, Laslett K, Gwini SM et al. (2019). Presentation and outcomes in hypertrophic pyloric stenosis: An 11-year review. J Paediatr Child Health. 55 (10): 1183-1187. https://doi.org/10.1111/jpc.14372; PMid:30677197

46. Zampieri N, Corato V, Scire G, Camoglio FS. (2021). Hypertrophic pyloric stenosis: 10 years' experience with standard open and laparoscopic approach. Pediatr Gastroenterol Hepatol Nutr. 24 (3): 265-272. https://doi.org/10.5223/pghn.2021.24.3.265; PMid:34046329 PMCid:PMC8128778

47. Zhu J, Zhu T, Lin Z et al. (2017). Perinatal risk factors for infantile hypertrophic pyloric stenosis: A meta-analysis. J Pediatr Surg. 52 (9): 1389-1397. https://doi.org/10.1016/j.jpedsurg.2017.02.017; PMid:28318599