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Pediatric laparoscopy: Facts and factitious claims
1Division of Pediatric Surgery, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India.
Insights
Pediatric laparoscopy (LS) is not proven to be superior to open surgery (OS) in children. Evidence suggests LS may be as or more invasive, with no clear benefits in complications or cost-effectiveness.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- The perceived superiority of pediatric laparoscopy (LS) over open surgery (OS) is widely claimed.
- This review critically evaluates the scientific evidence supporting these claims in pediatric patients.
Purpose of the Study:
- To systematically analyze published evidence comparing pediatric laparoscopy (LS) and open surgery (OS).
- To assess the scientific veracity of claims regarding LS superiority in infants and children.
Main Methods:
- A comprehensive search of the PubMed database was conducted.
- Analysis of available literature specifically on pediatric laparoscopy was performed.
Main Results:
- 108 articles were selected for detailed review from a total of 426 papers.
- High-quality evidence does not support LS as minimally invasive or more cost-effective than OS.
- Evidence regarding postoperative pain and cosmetic outcomes is inconclusive or lacking.
Conclusions:
- Pediatric laparoscopy (LS) is comparable to open surgery (OS), with no proven superiority.
- Evidence does not support claims of reduced invasiveness, fewer complications, or economic benefits of LS.
- Concerns exist regarding the rapid adoption and potential misuse of LS in pediatric surgery, especially in younger children.
Background:
Pediatric laparoscopy (LS) is claimed to be superior to open surgery (OS). This review questions the scientific veracity of this assertion by systematic analysis of published evidences comparing LS versus OS in infants and children.
Materials And Methods:
Search of PubMed data base and the available literature on pediatric LS is analyzed.
Results:
One hundred and eight articles out of a total of 426 papers were studied in detail.
Conclusions:
High quality evidences indicate that LS is, at the best, as invasive as OS; and is at the worst, more invasive than conventional surgery. There are no high quality evidences to suggest that LS is minimally invasive, economically profitable and is associated with fewer complications than OS. Evidences are equally distributed for and against the benefits of LS regarding postoperative pain. Proof of cosmetic superiority of LS or otherwise is not available. The author concludes that pediatric laparoscopy, at the best, is simply comparable to laparotomy and its superiority over the latter could not be sustained on the basis of available scientific evidences. Benefits of laparoscopy appear to recede with younger age. Concerns are raised on the quick adoption, undue promotion and frequent misuse of laparoscopy in children.
