Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Pediatr Surg Int. 2021 Aug;37(8):973-981. doi: 10.1007/s00383-021-04911-4. Epub 2021 May 1.
Surgical site infections (SSIs) are the most common healthcare-associated infections in patients undergoing surgery. Various randomised control trials (RCTs) indicate that laparoscopic procedures can be associated with better outcomes compared to open procedures. However, how open versus laparoscopic approaches compare across various paediatric procedures with respect to SSI rate remains poorly defined. In this review, we examined RCTs that directly compare SSI rates after open versus laparoscopic operations for appendicitis, gastro-esophageal reflux, inguinal hernia, and pyloric stenosis. MEDLINE, Embase, and Web of Science were searched for RCTs comparing four types of open versus laparoscopic operations in children. The operations included appendectomy, fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy. 364 records were identified and screened, 54 full-text articles were assessed for eligibility, and 17 RCTs were included in the analysis. SSI rate was the primary outcome. Operative time and length of stay (LOS) were the secondary outcomes. A meta-analysis was conducted using RevMan 5.4 software. Laparoscopic appendectomy had a lower SSI rate than open appendectomy (odds ratio of 2.22 [1.19, 4.15] p = 0.01). Laparoscopic fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy for pyloric stenosis were not associated with lower SSI rate compared to open surgery. Operative time was shorter in open fundoplication (- 71.22 min [- 89.79, - 52.65] p < 0.00001) than laparoscopic fundoplication. There was no significant difference in operative time of any of the other procedures. There was no significant difference in LOS between open and laparoscopic procedures for all types of operations analysed. Based on the findings of this review, it is recommended to utilise the laparoscopic approach over the open approach to reduce SSI risk in paediatric appendectomy.
手术部位感染（SSI）是接受手术的患者中最常见的与医疗保健相关的感染。各种随机对照试验（RCT）表明，与开放手术相比，腹腔镜手术可以带来更好的结果。然而，在 SSI 发生率方面，各种儿科手术中开放手术与腹腔镜手术的比较仍未得到明确界定。在本综述中，我们检查了直接比较阑尾炎、胃食管反流、腹股沟疝和幽门狭窄的开放与腹腔镜手术的 SSI 发生率的 RCT。我们在 MEDLINE、Embase 和 Web of Science 中搜索了比较儿童 4 种类型的开放与腹腔镜手术的 RCT。手术包括阑尾切除术、胃食管反流的胃底折叠术、腹股沟疝修补术或幽门肌切开术。确定了 364 条记录并进行了筛选，评估了 54 篇全文文章的资格，并纳入了 17 项 RCT 进行分析。SSI 发生率是主要结局。手术时间和住院时间（LOS）是次要结局。使用 RevMan 5.4 软件进行了荟萃分析。与开放阑尾切除术相比，腹腔镜阑尾切除术的 SSI 发生率较低（比值比为 2.22 [1.19, 4.15]，p=0.01）。腹腔镜胃底折叠术治疗胃食管反流、腹股沟疝修补术或幽门肌切开术治疗幽门狭窄与开放手术相比，并未降低 SSI 发生率。与腹腔镜手术相比，开放胃底折叠术的手术时间更短（-71.22 分钟[-89.79，-52.65]，p<0.00001）。其他任何手术的手术时间均无显著差异。所有分析的手术类型中，开放和腹腔镜手术的 LOS 之间无显著差异。基于本综述的结果，建议在小儿阑尾切除术中使用腹腔镜方法而不是开放方法，以降低 SSI 风险。
