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Pediatric surgical technique: laparoscopic or open approach? A systematic review and meta-analysis
M J Billingham1, S J Basterfield
1George Eliot Hospital, Medicine and Surgery, Nuneaton, United Kingdom. mbillingham@doctors.org.uk
Insights
Minimally invasive surgery (MIS) in pediatric populations offers better outcomes. Laparoscopic procedures show reduced length of stay and complication rates compared to open surgery, supporting increased MIS utilization for pediatric patients.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery (MIS)
- Comparative Effectiveness Research
Background:
- The efficacy of laparoscopic surgery in pediatric patients is debated.
- A systematic review was performed to compare laparoscopic versus open surgical approaches in children.
Purpose of the Study:
- To compare the clinical and cost-effectiveness of laparoscopic and open surgical methods in pediatric populations.
- To evaluate outcomes including length of stay, operating room time, complication rates, and hospital costs.
Main Methods:
- Comprehensive literature search of peer-reviewed publications comparing laparoscopic and open appendectomy, fundoplication, and hernia repair.
- Meta-analysis using the Mantel-Haenszel method to aggregate outcome rates.
Main Results:
- Laparoscopic surgery significantly reduced length of stay by -1.44 days but increased operating room time by +12.8 minutes.
- Laparoscopic procedures were associated with significantly lower complication rates (10.6%) compared to open procedures (15.6%).
- Total hospital costs for laparoscopic approaches were insignificantly increased compared to open techniques.
Conclusions:
- This review supports the use of minimally invasive surgery in pediatric populations.
- Laparoscopic procedures demonstrated improved patient outcomes, including reduced length of stay and complication rates.
- Increased adoption of MIS may benefit pediatric surgical patients.
Introduction:
The laparoscopic treatment of pediatric populations remains controversial. This review was conducted to compare the clinical and cost effectiveness of laparoscopic and open surgical approaches for a variety of surgical indications in pediatric populations.
Method/Design:
A computerized comprehensive search supplemented by a manual review of the literature was performed for all peer-reviewed publications comparing laparoscopic and open appendectomy, fundoplication and hernia repair cohorts. Outcomes of interest were length of stay (LOS), operating room (OR) time, complication rates and total hospital costs; aggregation of outcome rates was performed with the Mantel-Haenszel method.
Results:
A total of 24 articles were identified that met the search and inclusion criteria. LOS was found to be significantly reduced in favor of the laparoscopic approach, with a weighted mean difference of -1.44 days, although the OR time was significantly increased, with a weighted mean difference of +12.8 min. Laparoscopic intervention was associated with a significantly reduced complication rate compared to the open approach (10.6 vs. 15.6%). Total hospital costs of the laparoscopic approaches were found to be insignificantly increased compared to the open techniques.
Conclusion:
This review further supports the use of minimally invasive surgery (MIS) in pediatric populations, demonstrating that the three types laparoscopic procedures reviewed resulted in better patient outcomes compared to open procedures, in the form of reduced LOS and overall complication rates. Increased utilization of this approach may prove beneficial to pediatric patients.
