Journal de médecine et de chirurgie pédiatriques

Abstrait

This Year's APSA COVID 19, Paediatric Surgery, and the Moral Compass: Roberte E. Gross Lecture

Mary L Brandt

Introduction: Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There's still a call for well- innovated substantiation. 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 method: 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 anatomized for different types of procedures. Complications were distributed using the Clavien- Dindo bracket.

Results: An aggregate of 239 studies dealing with 19 types of procedures and issues in, 157 cases were anatomized. We linked 26 randomized controlled trials (10.8) and 213 relative studies (89.2). The most constantly reported advantage of laparoscopy was shorter sanitarium stay in60.4 of studies. Longer operative time was the most constantly reported disadvantage of laparoscopy in52.7 of studies. Clavier- Dindo grade I to III complications (mild-moderate) were less constantly linked in laparoscopic compared to open procedures (80.3 of studies). GradeIV complications (severe) were less constantly reported after laparoscopic versus open appendectomy for perforated appendicitis and more constantly after laparoscopic Kasai's portoenterostomy. We linked a dropped frequence 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 salutary in utmost types of procedures. The number of randomized controlled trials (rcts) remains limited. Still, the number of reports on disadvantages increased during the once decades.