title: Laparoscopic vs. open Nissen's fundoplication for gastro-oesophageal reflux disease in children: A meta-analysis.
abstract: OBJECTIVE
  Available evidence showed inconsistent results between laparoscopic Nissen's fundoplication (LNF) and open Nissen's fundoplication (ONF) for children with gastro-oesophageal reflux disease (GERD), so this study aimed to evaluate the efficacy and safety between LNF and ONF.
  
  
  METHODS
  Systematic, comprehensive literature searches were conducted to include randomized controlled trials (RCTs) that compared LNF and ONF for GERD. Two reviewers independently selected studies, abstracted data and assessed the methodological quality and evidence level. Data was analyzed by Review Manager Version 5.0. Risk ratio (RR) was used for dichotomous outcomes, and mean difference (MD) was used for continuous scales. Heterogeneity was estimated with the I2statistic, fixed-effect model was used if I2<50%, and otherwise random-effects model was used.
  
  
  RESULTS
  Three RCTs (171 children) were included. There was not a statistical difference in mortality (RR 1.12, 95%CI 0.50 2.48), or postoperative complications (RR 0.87, 95%CI 0.61 1.25), readmission (RR 1.53, 95%CI 0.67 3.51), or hospital stay (MD 0.85, 95%CI -0.06 1.75) between LNF and ONF. But LNF was associated with more incidence of recurrence (RR 3.32, 95%CI 1.40 7.84), longer surgery duration (MD 76.33, 95%CI 69.37 83.28), but fewer retching (RR 0.11, 95%CI 0.02 0.58) than ONF.
  
  
  CONCLUSIONS
  LNF might be as effective and safe as ONF in the short and long term, but both were associated with high risk of recurrence and mortality, especially for those children with neurological impairment, before the age of 18 months and female gender. This required a comprehensive evaluation of children before surgery.
authors.affiliation: Department of Pediatric Surgery, Nanyang Central Hospital, Nanyang, Henan Province, 47300, China. Electronic address: zhp-118@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Neonatal Intensive Care Unit, Nanyang Central Hospital, Nanyang, Henan Province, 47300, China. Electronic address: 41479022@qq.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Tian
authors.affiliation: Zonglian College, Xi'an Jiaotong University, Xi'an, Shaanxi, 710033, China. Electronic address: 564095454@qq.com.
authors.forename: Li
authors.initials: L
authors.lastname: Jing
authors.affiliation: Department of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, Xijing Hospital, Four Military Medical University, Xi'an, Shaanxi, 710033, China. Electronic address: 371438006@qq.com.
authors.forename: Quan
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Evidence Based Medicine Center, School of Basic Medical Science of Lanzhou University, Lanzhou, Gansu, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, 730000, China. Electronic address: tjh996@163.com.
authors.forename: Jinhui
authors.initials: J
authors.lastname: Tian
authors.affiliation: Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410000, China. Electronic address: guo19880101@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Lun
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence
keywords: Children; Gastro-oesophageal reflux disease; Laparoscopic Nissen's fundoplication; Open Nissen's fundoplication