Trainee involvement in laparoscopic pyloromyotomy does not compromise outcomes: evidence from a longitudinal institutional experience

PURPOSE: To evaluate whether supervised pediatric surgery trainees can safely perform laparoscopic pyloromyotomy (LP) and to assess the influence of trainee participation within the institutional learning curve. METHODS: A retrospective single-center cohort included all infants undergoing LP between June 2011-2025. Cases were categorized as specialist- or trainee-performed (eight pediatric surgery specialists, three supervised trainees). Baseline characteristics, operative variables, surgery-related complications, incomplete pyloromyotomy, postoperative recovery, reintervention, and readmission were compared. Temporal trends and institutional CUSUM analysis were performed. RESULTS: Seventy-seven infants were included (45 specialist-operated, 32 trainee-operated). Baseline characteristics were similar. Operative time was longer for trainees (45 versus 40 min, p = 0.037). Surgery-related complications occurred in 11.1% of specialist cases and in none of the trainee cases (p=0.07). All five complications (two wound infections, one incisional omental exteriorization, and two mucosal perforations) occurred with specialists. One incomplete pyloromyotomy occurred (trainees). The composite adverse outcome rate was 11.1% (specialists) versus 3.1% (trainees) (p = 0.39). Feeding progression, length of stay, reoperations and readmissions were comparable. CUSUM analysis demonstrated no adverse drift after trainee integration. CONCLUSION: Supervised trainees safely performed LP with outcomes comparable to specialists. Slightly longer operative time did not impact recovery. Early trainee involvement did not compromise patient safety or institutional performance.