Miyake Hiromu, Seo Shogo, Pierro Agostino
Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
Pediatr Surg Int. 2018 Feb;34(2):177-182. doi: 10.1007/s00383-017-4186-0. Epub 2017 Oct 10.
Adhesive small bowel obstruction (ASBO) is one of the most important cause of postoperative morbidity in children who underwent abdominal surgery. Laparoscopic management for ASBO in pediatric patients has been reported. However, its safety and efficacy has not been evaluated in details. The aim of this study is to compare the outcomes of laparoscopy and laparotomy for the treatment of ASBO in children.
A systematic review and meta-analysis were performed following the Cochrane Handbook for systematic reviews of intervention and the preferred reporting item for systematic reviews and meta-analysis (PRISMA) and a protocol registered in PROSPERO (CRD42017067914). The primary outcome was the number of intraoperative and postoperative complications. The secondary outcome was length of hospital stay. The risk of bias in non-randomized studies of interventions (ROBINS-I) tool was used to assess the risk of bias. Quality of evidence was summarized using the grades of recommendation, assessment, development and evaluation (GRADE) approach.
We identified three observational studies and no randomized controlled trials. The meta-analysis was done only for the primary outcome. Complications were significantly fewer after laparoscopy compared to laparotomy (Odds ratio = 0.51; 95% CI 0.40-0.66; p < 0.01; I : 0%). The overall risk of bias was considered serious.
Our results, based on observational studies, indicate that laparoscopy for ASBO was associated with less postoperative complications compared to conventional laparotomy. However, the quality of evidence is very low. A well-controlled study is needed to assess the efficacy of laparoscopy for pediatric patients with ASBO.
粘连性小肠梗阻（ASBO）是接受腹部手术儿童术后发病的最重要原因之一。已有关于小儿ASBO腹腔镜治疗的报道。然而，其安全性和有效性尚未得到详细评估。本研究的目的是比较腹腔镜手术和开腹手术治疗儿童ASBO的效果。
按照Cochrane干预系统评价手册以及系统评价和Meta分析的首选报告项目（PRISMA）进行系统评价和Meta分析，并在PROSPERO（CRD42017067914）注册了方案。主要结局是术中和术后并发症的数量。次要结局是住院时间。采用干预性非随机研究的偏倚风险（ROBINS-I）工具评估偏倚风险。使用推荐分级、评估、制定与评价（GRADE）方法总结证据质量。
我们纳入了三项观察性研究，未纳入随机对照试验。仅对主要结局进行了Meta分析。与开腹手术相比，腹腔镜手术后并发症明显更少（优势比=0.51；95%可信区间0.40-0.66；p<0.01；I²：0%）。总体偏倚风险被认为很严重。
基于观察性研究的结果表明，与传统开腹手术相比，腹腔镜治疗ASBO术后并发症更少。然而，证据质量非常低。需要进行一项严格对照的研究来评估腹腔镜手术治疗小儿ASBO的疗效。
