Pediatric surgical technique: laparoscopic or open approach? A systematic review and meta-analysis.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Billingham
M J
MJ
George Eliot Hospital, Medicine and Surgery, Nuneaton, United Kingdom. mbillingham@doctors.org.uk
Basterfield
S J
SJ
D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D016896:Treatment Outcome