Raveenthiran V
Division of Pediatric Surgery, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India.
J Indian Assoc Pediatr Surg. 2010 Oct;15(4):122-8. doi: 10.4103/0971-9261.72434.
Pediatric laparoscopy (LS) is claimed to be superior to open surgery (OS). This review questions the scientific veracity of this assertion by systematic analysis of published evidences comparing LS versus OS in infants and children.
Search of PubMed data base and the available literature on pediatric LS is analyzed.
One hundred and eight articles out of a total of 426 papers were studied in detail.
High quality evidences indicate that LS is, at the best, as invasive as OS; and is at the worst, more invasive than conventional surgery. There are no high quality evidences to suggest that LS is minimally invasive, economically profitable and is associated with fewer complications than OS. Evidences are equally distributed for and against the benefits of LS regarding postoperative pain. Proof of cosmetic superiority of LS or otherwise is not available. The author concludes that pediatric laparoscopy, at the best, is simply comparable to laparotomy and its superiority over the latter could not be sustained on the basis of available scientific evidences. Benefits of laparoscopy appear to recede with younger age. Concerns are raised on the quick adoption, undue promotion and frequent misuse of laparoscopy in children.
小儿腹腔镜手术（LS）据称优于开放手术（OS）。本综述通过系统分析已发表的比较婴儿和儿童LS与OS的证据，对这一论断的科学真实性提出质疑。
分析了PubMed数据库搜索结果及有关小儿LS的现有文献。
在总共426篇论文中，对108篇文章进行了详细研究。
高质量证据表明，LS充其量与OS的侵入性相当；最糟糕的是，其侵入性比传统手术更大。没有高质量证据表明LS是微创的、具有经济效益且并发症比OS少。关于LS对术后疼痛有益与否的证据分布相当。没有证据证明LS在美观方面具有优越性。作者得出结论，小儿腹腔镜手术充其量只是与剖腹手术相当，基于现有科学证据，其相对于后者的优越性无法成立。腹腔镜手术的益处似乎随着年龄的减小而减弱。人们对腹腔镜手术在儿童中的迅速采用、过度推广和频繁滥用表示担忧。
