Pyloric stenosis: from a retrospective analysis to a prospective clinical trial - the impact on surgical outcomes.
Pyloric stenosis is the most common surgical condition of infants. The operative approach, however, is currently debated in the literature following the application of laparoscopic and circumumbilical techniques to facilitate the pyloromyotomy. In this review, we will examine the published data and critically evaluate the influence of prospective data in delineating truths and illuminating flaws of retrospective data on a controversial topic. Retrospective data are highly discordant on the influence an operative approach for pyloromyotomy has on operating time, time to goal feeds, length of stay and complications. Prospective randomized data demonstrate that when the postoperative management is controlled, the approach does not influence length of recovery in a clinically relevant manner. Prospective data also demonstrate that the operating time can be the same for the laparoscopic and open approaches with no differences in complications for centers with good laparoscopic volume. There are no prospective data to contrast the circumumbilical approach with the other approaches; however there is an inherent and obvious cosmetic advantage to the laparoscopic and circumumbilical approaches, which avoid a large epigastric incision. The laparoscopic approach does not appear to influence length of recovery compared to the open operation. Prospective data show the laparoscopic approach results in less postoperative pain and can be done with no increase in operating time or complications.