Predictors and incidence of intraoperative and postoperative complications in infant pyloromyotomy: a meta-analysis

Abstract

Infantile pyloromyotomy remains the definitive surgical treatment for hypertrophic pyloric stenosis (HPS). While generally considered safe and effective, both intraoperative and postoperative complications can arise, impacting patient recovery and overall outcomes. This meta-analysis aimed to evaluate the incidence systematically and identify predictors of intraoperative and postoperative complications associated with infantile pyloromyotomy. A comprehensive systematic literature search was performed across PubMed, Embase, Scopus, and the Cochrane Library (Jaunary2016 to March 2026) to identify studies reporting intraoperative and postoperative complications after infantile pyloromyotomy. Eligible studies included randomized controlled trials, prospective and retrospective cohort studies, and observational analyses. Two independent reviewers extracted data on complication types, incidence rates, and potential risk factors. Pooled incidence rates were calculated using random-effects meta-analysis models, and subgroup analyses investigated the influence of surgical approach (open vs. laparoscopic), patient characteristics (e.g., prematurity, low birth weight), and surgeon experience. Across included studies, the overall pooled incidence of complications ranged from X-Y%. The most frequently reported complications included mucosal perforation, incomplete pyloromyotomy, wound infection, and persistent postoperative vomiting. Significant predictors of increased complication risk identified were prematurity, low birth weight, presence of coexisting comorbidities, and lower surgeon experience. Both open and laparoscopic pyloromyotomy methods had similar overall safety profiles, but there were some small differences in the types of complications that occurred with each method. Infantile pyloromyotomy is still a safe procedure with low rates of serious complications. Identification and awareness of both patient and procedure related risk factors are crucial for optimizing surgical planning, enhancing patient outcomes, and facilitating comprehensive parental counseling. Future high quality, multicenter prospective studies are warranted to further refine risk stratification models and optimize perioperative management protocols.