COMPARATIVE EFFICACY OF MINIMALLY INVASIVE SURGICAL TECHNIQUES VERSUS OPEN SURGERY IN CONGENITAL HYPERTROPHIC PYLORIC STENOSIS: SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction. Congenital hypertrophic pyloric stenosis is one of the most common pathologies in the neonatal period and the first months of life, requiring urgent surgical treatment. For a long time, the standard treatment was open pyloromyotomy (Ramstedt stenosis), performed through a laparotomy. However, with the development of minimally invasive surgical techniques, laparoscopic pyloromyotomy (LP) has become widespread. Despite the widespread use of LP, questions remain regarding its comparative effectiveness and safety in modern pediatric surgery.

Materials and Methods. The authors conducted a systematic search of publications in PubMed, Science Direct, eLIBRARY, and Google Scholar databases in Russian and English for the period from 2010 to 2025. The risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. A random-effects model was used for quantitative data synthesis, assessing outcomes such as surgical duration, hospital stay, and the risk of intraoperative duodenal mucosal perforation.

Results. Data from 9 studies were included in the meta-analysis. No statistically significant differences were found between LP and OP for the primary outcomes: the pooled mean difference for operation duration was -1.62 minutes (95% CI: -17.39 to 14.15; p=0.765), for length of hospital stay it was -1.06 days (95% CI: -2.59 to 0.47; p=0.115), and the pooled relative risk for intraoperative mucosal perforation was 1.26 (95% CI: 0.45–3.57; p=0.587). At the same time, extremely high statistical heterogeneity was observed for continuous outcomes (I² > 90%). The overall certainty of evidence, assessed using the GRADE methodology, was low.

Conclusions. The results of the systematic review and meta-analysis, based on quantitative synthesis, do not allow for a definitive conclusion regarding the superiority of LP or OP for key perioperative outcomes. However, a comprehensive analysis of qualitative data demonstrates that LP is associated with a comparable safety profile, as well as a number of potentially clinically significant benefits, such as reduced pain severity, early recovery and transition to enteral feeding, and improved cosmetic results.