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Surgical site infection after open and laparoscopic surgery in children: a systematic review and meta-analysis
Mashriq Alganabi1, George Biouss1, Agostino Pierro2
1Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Insights
Laparoscopic appendectomy reduces surgical site infection (SSI) risk in children compared to open surgery. However, laparoscopic approaches for other common pediatric procedures like hernia repair do not show a lower SSI rate.
Area of Science:
- Pediatric Surgery
- Infectious Disease Control
- Minimally Invasive Surgery
Background:
- Surgical site infections (SSIs) are a significant concern in healthcare settings, particularly post-operatively.
- While randomized control trials (RCTs) suggest benefits of laparoscopic over open procedures, their comparative efficacy regarding SSIs in pediatric surgery is not well-defined.
- This review focuses on comparing SSI rates between open and laparoscopic approaches for specific common pediatric surgical procedures.
Purpose of the Study:
- To systematically review and analyze randomized control trials (RCTs) comparing surgical site infection (SSI) rates between open and laparoscopic surgical approaches in children.
- To evaluate secondary outcomes including operative time and length of stay (LOS) for these procedures.
Main Methods:
- A comprehensive literature search was conducted across MEDLINE, Embase, and Web of Science to identify RCTs directly comparing open versus laparoscopic surgery for pediatric appendicitis, gastro-esophageal reflux, inguinal hernia, and pyloric stenosis.
- Seventeen RCTs involving 364 initially identified records were included in the meta-analysis.
- Surgical site infection (SSI) rate was the primary outcome, with operative time and length of stay (LOS) as secondary outcomes, analyzed using RevMan 5.4 software.
Main Results:
- Laparoscopic appendectomy demonstrated a significantly lower SSI rate compared to open appendectomy (OR 2.22 [1.19, 4.15], p=0.01).
- No significant difference in SSI rates was observed for laparoscopic versus open procedures for gastro-esophageal reflux, inguinal hernia repair, or pyloric stenosis.
- Operative time was shorter for open fundoplication than laparoscopic, with no significant differences in operative time or LOS for other procedures analyzed.
Conclusions:
- The laparoscopic approach is recommended over the open approach for pediatric appendectomy to reduce the risk of surgical site infections (SSIs).
- For pediatric fundoplication, inguinal hernia repair, and pyloromyotomy, current evidence does not support a lower SSI risk with laparoscopic techniques compared to open surgery.
- Further research may be needed to clarify the role of minimally invasive surgery in reducing SSIs for these other pediatric conditions.
Abstract:
Surgical site infections (SSIs) are the most common healthcare-associated infections in patients undergoing surgery. Various randomised control trials (RCTs) indicate that laparoscopic procedures can be associated with better outcomes compared to open procedures. However, how open versus laparoscopic approaches compare across various paediatric procedures with respect to SSI rate remains poorly defined. In this review, we examined RCTs that directly compare SSI rates after open versus laparoscopic operations for appendicitis, gastro-esophageal reflux, inguinal hernia, and pyloric stenosis. MEDLINE, Embase, and Web of Science were searched for RCTs comparing four types of open versus laparoscopic operations in children. The operations included appendectomy, fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy. 364 records were identified and screened, 54 full-text articles were assessed for eligibility, and 17 RCTs were included in the analysis. SSI rate was the primary outcome. Operative time and length of stay (LOS) were the secondary outcomes. A meta-analysis was conducted using RevMan 5.4 software. Laparoscopic appendectomy had a lower SSI rate than open appendectomy (odds ratio of 2.22 [1.19, 4.15] p = 0.01). Laparoscopic fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy for pyloric stenosis were not associated with lower SSI rate compared to open surgery. Operative time was shorter in open fundoplication (- 71.22 min [- 89.79, - 52.65] p < 0.00001) than laparoscopic fundoplication. There was no significant difference in operative time of any of the other procedures. There was no significant difference in LOS between open and laparoscopic procedures for all types of operations analysed. Based on the findings of this review, it is recommended to utilise the laparoscopic approach over the open approach to reduce SSI risk in paediatric appendectomy.
