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Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies
Rim Kiblawi1, Christoph Zoeller1,2, Andrea Zanini3
1Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
Insights
Laparoscopic pediatric surgery generally offers benefits over open procedures, including shorter hospital stays and fewer mild-to-moderate complications. However, evidence from randomized controlled trials remains limited, and reports of disadvantages have increased over time.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- The comparative effectiveness of laparoscopic versus open pediatric surgery is debated.
- A comprehensive review of existing literature is needed to establish evidence-based conclusions.
- Previous studies have explored advantages and disadvantages of both surgical approaches.
Purpose of the Study:
- To systematically review and analyze studies comparing laparoscopic and open pediatric surgery.
- To evaluate the advantages and disadvantages of laparoscopic surgery across various pediatric procedures.
- To assess complication rates using the Clavien-Dindo classification.
Main Methods:
- A literature search was conducted on PubMed/MEDLINE for comparative studies.
- Included procedures covered gastrointestinal, hepatobiliary, pancreas, and spleen surgeries in children.
- Analysis focused on reported advantages, disadvantages, and complications, categorized by severity.
Main Results:
- 239 studies involving over 929,000 patients were analyzed.
- Shorter hospital stay was the most common laparoscopic advantage; longer operative time was the most frequent disadvantage.
- Mild-to-moderate complications were less frequent with laparoscopy, but severe complications varied by procedure.
Conclusions:
- Laparoscopic pediatric surgery appears advantageous for most procedures compared to open surgery.
- The body of evidence from randomized controlled trials is still limited.
- There has been a trend towards increased reporting of disadvantages for laparoscopic surgery over the decades.
Introduction:
Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. We reviewed the literature on studies published in the last three decades and dealing with advantages and disadvantages of laparoscopy compared to open surgery.
Materials And Methods:
Studies comparing laparoscopic versus open abdominal procedures in children were searched in PubMed/MEDLINE. Reports on upper and lower gastrointestinal as hepatobiliary surgery and on surgery of pancreas and spleen were included. Advantages and disadvantages of laparoscopic surgery were analyzed for different types of procedures. Complications were categorized using the Clavien-Dindo classification.
Results:
A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien-Dindo grade I to III complications (mild-moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency of reporting on advantages after laparoscopy and increased reporting on disadvantages for all surgery types over the decades.
Conclusion:
Laparoscopic compared with open pediatric surgery seems to be beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.
