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Single-incision versus conventional multiport laparoscopic-assisted surgery for Meckel's diverticulum in children: a
Zhuojun Xie1, Wei Feng2, Xiaohong Die2
1Department of General trauma surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Children's Hospital of Chongqing Medical University, Chongqing, China.
Background:
Meckel's diverticulum (MD) is the most common congenital anomaly of the small intestine, and often leads to various complications in children. This study aims to compare the efficacy and safety of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) in the treatment of MD in children.
Methods:
Retrospective review of patients who underwent laparoscopic surgery for MD at a tertiary pediatric hospital from February 2017 to February 2023 was conducted with registered of demographic information, preoperative laboratory results, operative findings, and postoperative outcomes. Based on the surgical strategy, patients were classified into SILS and CLS groups. Propensity score matching (PSM) was employed to adjust for confounding factors, resulting in 188 matched pairs. Using PSM, the two groups were compared for baseline differences and postoperative outcomes.
Results:
Of the 561 patients, the SILS-to-CLS ratio was 301: 260. After one-to-one PSM, results showed that compared with the CLS group, the SILS group had a significantly shorter postoperative hospital stay (P = 0.004), and earlier excretion time and fasting time (P < 0.05). Furthermore, SILS resulted in better scar assessment and higher satisfaction score (both P < 0.05). The two groups had no significant differences in the rates of postoperative complications (P = 0.439) and readmission (P = 0.291). Conversion to open surgery was more common in the SILS group (10.6%) than in the CLS group (6.4%), although this difference was not statistically significant after matching (P = 0.139).
Conclusion:
Our study aimed to determine the superiority of SILS over CLS in the treatment of pediatric MD. SILS offers distinct advantages over CLS in managing MD in children, including shorter hospital stays and bowel function recovery, without increasing postoperative complications. These findings suggest that SILS may be a preferable approach, warranting its integration into standard clinical practice for MD treatment.
Insights
Single-incision laparoscopic surgery (SILS) for Meckel's diverticulum (MD) in children offers shorter hospital stays and faster recovery than conventional laparoscopic surgery (CLS). SILS provides comparable safety and efficacy, making it a favorable option for pediatric MD treatment.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Congenital Anomalies
Background:
- Meckel's diverticulum (MD) is the most common congenital small intestine anomaly in children.
- MD complications necessitate surgical intervention, with laparoscopic approaches being standard.
Purpose of the Study:
- To compare the efficacy and safety of single-incision laparoscopic surgery (SILS) versus conventional laparoscopic surgery (CLS) for treating pediatric Meckel's diverticulum.
- To evaluate postoperative outcomes, including hospital stay, recovery, complications, and patient satisfaction.
Main Methods:
- Retrospective review of 561 pediatric patients with MD from February 2017 to February 2023.
- Propensity score matching (PSM) created 188 matched pairs for SILS and CLS groups.
- Comparison of demographic data, operative findings, and postoperative outcomes between the matched groups.
Main Results:
- SILS group showed significantly shorter postoperative hospital stays, earlier excretion, and fasting times compared to CLS (P < 0.05).
- SILS resulted in superior scar assessment and higher patient satisfaction scores (P < 0.05).
- No significant differences were observed in complication or readmission rates between SILS and CLS groups.
Conclusions:
- Single-incision laparoscopic surgery (SILS) is a safe and effective alternative to conventional laparoscopic surgery (CLS) for pediatric Meckel's diverticulum.
- SILS offers advantages in terms of reduced hospital stay, faster bowel function recovery, and improved cosmetic outcomes.
- The findings support the integration of SILS into standard clinical practice for managing pediatric MD.
