| Abstract | Ciljevi: Cilj ovog istraživanja bio je usporediti ishode liječenja u dojenčadi s hipertrofičnom
stenozom pilorusa između tradicionalnog, otvorenog pristupa i laparoskopske piloromiotomije.
Ispitanici i postupci: Ukupno 125 dojenčadi, 104 (83,2%) muškog spola, sa srednjom dobi od
33 (IQR 24; 40) dana, koji su podvrgnuti piloromiotomiji zbog hipertrofične stenoze pilorusa
između 2005. i 2021. godine, uključeno je u retrospektivnu studiju. Od toga 61 (48,8%) dijete
bilo je podvrgnuto otvorenoj piloromiotomiji, a njih 64 (51,2%) laparoskopskom zahvatu.
Skupine su uspoređene s obzirom na duljinu trajanja operacijskog zahvata, vrijeme do početka
hranjenja na usta, vrstu i stopu komplikacija, učestalost reoperacija, učestalost
poslijeoperacijskog povraćanja i duljinu boravka u bolnici.
Rezultati: Nisu pronađene razlike osnovnih karakteristika između dvije ispitivane skupine
(dob, spol, tjelesna masa, hipokalijemija, hipokloremija, metabolička alkaloza, pridružene
anomalije). Laparoskopski pristup bio je povezan sa značajno boljim ishodima liječenja u
usporedbi s otvorenim pristupom: kraća duljina trajanja operacijskog zahvata (35 min (IQR 30;
45)) naspram 45 min (IQR 40; 57,5); P<0,001), kraće vrijeme do oralnog unosa (6 h (IQR 4; 8)
u odnosu na 22 h (IQR 13,5; 24); P<0,001), manja učestalost poslijeoperacijskog povraćanja
(n=10 (15,6%) naspram n=19 (31,1%) P=0,039) i kraća duljina hospitalizacije (3 dana (IQR 2;
3) naspram 6 dana (IQR 4,5; 8); P<0,001). Stopa komplikacija i reoperacija bile su niže u
skupini bolesnika podvrgnutih laparoskopskoj piloromiotomiji, ali razlike nisu bile statistički
značajne (P=0,157, odnosno P=0,113). Najčešća komplikacija u obje skupine bila je perforacija
sluznice (otvorena skupina, n=3 (4,9%); laparoskopska skupina, n=2 (3,1%)). Druga po
učestalosti bila je infekcija rane s n=3 (4,9%) u otvorenoj skupini i nijednim zabilježenim
slučajem u laparoskopskoj skupini.
Zaključci: Otvorena i laparoskopska piloromiotomija jednako su sigurne i učinkovite u
liječenju hipertrofične stenoze pilorusa. Laparoskopska tehnika povezana je s bržim
oporavkom, kraćim trajanjem operacije i kraćim boravkom u bolnici. |
| Abstract (english) | Objectives: The aim of the present study was to compare outcomes of treatment in infants with
hypertrophic pyloric stenosis between traditional open approach and laparoscopic
pyloromyotomy.
Subjects and methods: A total of 125 infants, 104 (83.2%) males, with median age 33 (IQR
24, 40) days, who underwent pyloromyotomy because of hypertrophic pyloric stenosis,
between 2005 and 2021, were included in the retrospective study. Of that number 61 (48.8%)
infants were allocated to the open group and 64 (51.2%) to the laparoscopic group. The groups
were compared in regards to time to oral intake, duration of surgery, the type and rate of
complications, rate of reoperations, frequency of vomiting after surgery and the length of
hospital stay.
Results: No differences were found in regards to baseline characteristics between two
investigated groups. Laparoscopic approach was associated with significantly better outcomes
compared to open approach: shorter duration of surgery (35 min (IQR 30; 45) vs. 45 min (IQR
40; 57.5); P<0.001), shorter time to oral intake (6 h (IQR 4; 8) vs. 22 h (IQR 13.5; 24);
P<0.001), lower frequency of postoperative vomiting (n=10 (15.6%) vs. n=19 (31.1%)) and
shorter length of postoperative hospital stay (3 days (IQR 2; 3) vs. 6 days (IQR 4.5; 8); P<
0.001). In regards to complications and reoperation rates, both were lower in the laparoscopic
pyloromyotomy group but the differences were not statistically significant (P=0.157 and P=
0.113, respectively). The most common complication in both groups was mucosal perforation
(open group, n=3 (4.9%); laparoscopic group, n=2 (3.1%)) followed by wound infection in open
group, n=3 (4.9%). No cases of wound infection were recorded in the laparoscopic group.
Conclusions: Open and laparoscopic pyloromyotomy are equally safe and effective in
treatment of hypertrophic pyloric stenosis. Laparoscopic technique is associated with faster
recovery, shorter duration of surgery and shorter duration of hospital stay. |
