Small evidence for small incisions: pediatric laparoscopy and the need for more rigorous evaluation of novel surgical therapies.

摘要: Abstract Background/purpose Laparoscopic surgery has been widely adopted for many pediatric surgical diseases its potential to reduce morbidity and hospital stay. To date, no study examined the qualitative state of evidence supporting use these techniques in children. The authors present a systematic objective review this evidence. Methods identified all clinical reports during last 10 years 3 most common managed laparoscopically (appendicitis, gastroesophageal reflux, conditions requiring splenectomy). Standardized previously validated quality assessment instruments were used examine individual studies 4 areas: (1) relevance, (2) generalizability practice, (3) reporting methodology, (4) strength conclusions. Results evaluated total 131 (39 48 per disease). Ninety-three percent retrospective, with single institution case accounting majority Only 23% control group any kind. Randomized trials comprised 3% (4 studies). Forty-five nonrandomized found be poor quality, 55% fair by epidemiologic standards. distribution scores was not significantly different between operative indications (analysis variance P =0.10). also methodologic standardized criteria. Conclusions current body is insufficient justify widespread adoption laparoscopic into accepted standards care. Wider prospective such as multicenter databases randomized are needed clarify outcomes innovative techniques. Significant improvement published observational warranted, may facilitated guidelines specific data.