What surgical approach would provide better outcomes in children and adolescents undergoing cholecystectomy? Results of a systematic review and meta-analysis

Annals of Pediatric Surgery - Tập 16 - Trang 1-10 - 2020
Daniel Steffens1,2, Kathryn Wales1,2, Clare Toms1,2, David Yeo1,2,3,4, Charbel Sandroussi1,2,3,4, Ashish Jiwane5
1Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia
2Faculty of Medicine and Health, The University of Sydney, Central Clinical School, Sydney, Australia
3Upper Gastrointestinal Department, Royal Prince Alfred Hospital, Sydney, Australia
4RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
5Department of Paediatric Surgery, Sydney Children Hospital, Randwick, Australia

Tóm tắt

There is a lack of evidence on the surgical approach for children and adolescents undergoing cholecystectomy. Therefore, the aim of this systematic review is to compare the safety and efficacy of minimally invasive cholecystectomy to open cholecystectomy in children and/or adolescents. A search was conducted on MEDLINE, PubMed, Cochrane and Embase from inception to October 2018. We included comparative studies investigating outcomes following robotic-assisted, laparoscopic and/or open cholecystectomy in children and/or adolescents. The outcomes of interest included post-operative complication rate, operation time, length of hospital stay, post-operative pain and conversion to open procedure. The Newcastle-Ottawa Scale was used to assess the risk of bias. Meta-analysis was performed using random-effect models. Twenty-one studies were included involving 927 children and/or adolescents. All, but one, compared outcomes between laparoscopic versus open cholecystectomy. The great majority of the included studies presented a low risk of bias. Patients undergoing laparoscopic cholecystectomy had less post-operative complications (RR: 0.57; 95%CI 0.35 to 0.94), reduced length of hospital stay (MD − 3.73; 95%CI − 4.88 to − 2.59), but longer operative time (MD 26.61; 95%CI 9.35 to 43.86) when compared to open cholecystectomy. The average conversion from laparoscopic to open cholecystectomy was 7% across studies. The current evidence suggested that laparoscopic cholecystectomy in children and/or adolescents is safe resulting in lower rates of postoperative complications and length of stay, but longer operative times, when compared to the open approach. CRD42017067641 Level III

Tài liệu tham khảo

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Annals of Pediatric Surgery

Tập 16

1-10

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