Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

2021 ◽  
Author(s):  
Rim Kiblawi ◽  
Christoph Zoeller ◽  
Andrea Zanini ◽  
Joachim F. Kuebler ◽  
Carmen Dingemann ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Comparative Studies ◽  
Pediatric Surgery ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
Controlled Trials ◽  
Advantages And Disadvantages ◽  
Randomized Controlled ◽  
Different Types ◽  
Laparoscopic Versus Open Appendectomy

Abstract Introduction Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. 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 Methods 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 analyzed for different types of procedures. Complications were categorized using the Clavien–Dindo classification. Results A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien–Dindo grade I to III complications (mild–moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency 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 beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.

Thirty Years of Minimally Invasive Surgery in Children: Analysis of Meta-Analyses

2019 ◽  
Vol 30 (05) ◽  
pp. 420-428 ◽  
Author(s):  
Joachim F. Kuebler ◽  
Jens Dingemann ◽  
Benno M. Ure ◽  
Nagoud Schukfeh
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Randomized Controlled Trials ◽  
Invasive Surgery ◽  
Pediatric Surgery ◽  
Controlled Trials ◽  
Advantages And Disadvantages ◽  
Randomized Controlled ◽  
Lower Complication ◽  
Meta Analyses

Abstract Introduction In the last three decades, minimally invasive surgery (MIS) has been widely used in pediatric surgery. Meta-analyses (MAs) showed that studies comparing minimally invasive with the corresponding open operations are available only for selected procedures. We evaluated all available MAs comparing MIS with the corresponding open procedure in pediatric surgery. Materials and Methods A literature search was performed on all MAs listed on PubMed. All analyses published in English, comparing pediatric minimally invasive with the corresponding open procedures, were included. End points were advantages and disadvantages of MIS. Results of 43 manuscripts were included. MAs evaluating the minimally invasive with the corresponding open procedures were available for 11 visceral, 4 urologic, and 3 thoracoscopic types of procedures. Studies included 34 randomized controlled trials. In 77% of MAs, at least one advantage of MIS was identified. The most common advantages of MIS were a shorter hospital stay in 20, a shorter time to feeding in 11, and a lower complication rate in 7 MAs. In 53% of MAs, at least one disadvantage of MIS was found. The most common disadvantages were longer operation duration in 16, a higher recurrence rate of diaphragmatic hernia in 4, and gastroesophageal reflux in 2 MAs. A lower native liver survival rate after laparoscopic Kasai-portoenterostomy was reported in one MA. Conclusion In the available MAs, the advantages of MIS seem to outnumber the disadvantages. However, for some types of procedures, MIS may have considerable disadvantages. More randomized controlled trials are required to confirm the advantage of MIS for most procedures.

Making a Difference

2018 ◽  
Author(s):  
Rani Lill Anjum ◽  
Stephen Mumford
Keyword(s):  
Randomized Controlled Trials ◽  
Comparative Studies ◽  
Gold Standard ◽  
Controlled Trials ◽  
Positive Difference ◽  
Randomized Controlled ◽  
Difference Making ◽  
Making A Difference ◽  
Difference Makers ◽  
Trial Intervention

One view of what links a cause to an effect is that causes make a difference to whether or not the effect is produced. This assumption is behind comparative studies, such as the method of randomized controlled trials, aimed at showing whether a trial intervention makes a positive difference to outcomes. Comparative studies are regarded as the gold standard in some areas of research but they are also problematic. There can be causes that make no difference and some difference-makers that are not causes. This indicates that difference-making should be taken as a symptom of causation: a feature that accompanies it in some, though not all, cases. Symptoms can be useful in the discovery of causes but they cannot be definitive of causation.

Use of Sham Interventions in Randomized Controlled Trials in Neurosurgery

2020 ◽  
Vol 81 (05) ◽  
pp. 456-462
Author(s):  
Rodrigo Panico Gorayeb ◽  
Maria João Forjaz ◽  
António Gonçalves Ferreira ◽  
Joaquim José Ferreira
Keyword(s):  
Randomized Controlled Trials ◽  
Peripheral Nerves ◽  
Brain Injuries ◽  
Controlled Trials ◽  
Ethical Concerns ◽  
Administration Routes ◽  
Randomized Controlled ◽  
Different Types ◽  
Double Blinded ◽  
Clinical Problems

Abstract Background The use of sham interventions in randomized controlled trials (RCTs) is essential to minimize bias. However, their use in surgical RCTs is rare and subject to ethical concerns. To date, no studies have looked at the use of sham interventions in RCTs in neurosurgery. Methods This study evaluated the frequency, type, and indication of sham interventions in RCTs in neurosurgery. RCTs using sham interventions were also characterized in terms of design and risk of bias. Results From a total of 1,102 identified RCTs in neurosurgery, 82 (7.4%) used sham interventions. The most common indication for the RCT was the treatment of pain (67.1%), followed by the treatment of movement disorders and other clinical problems (18.3%) and brain injuries (12.2%). The most used sham interventions were saline injections into spinal structures (31.7%) and peripheral nerves (10.9%), followed by sham interventions in cranial surgery (26.8%), and spine surgery (15.8%). Insertion of probes or catheters for a sham lesions was performed in 14.6%.In terms of methodology, most RCTs using sham interventions were double blinded (76.5%), 9.9% were single blinded, and 13.6% did not report the type of blinding. Conclusion Sham-controlled RCTs in neurosurgery are feasible. Most aim to minimize bias and to evaluate the efficacy of pain management methods, especially in spinal disorders. The greatest proportion of sham-controlled RCTs involves different types of substance administration routes, with sham surgery the less commonly performed.

scholarly journals Randomized Controlled Trials for Comparison of Laparoscopic Versus Conventional Open Catheter Placement in Peritoneal Dialysis Patients: A Meta-Analysis

2020 ◽  
Author(s):  
Mei-Lan Sun ◽  
Yong Zhang(Former Corresponding Author) ◽  
Bo Wang ◽  
Tean Ma ◽  
Hong Jiang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Catheter Placement ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Large Sample Size ◽  
Advantages And Disadvantages ◽  
Randomized Controlled ◽  
Significant Difference

Abstract Aim: The application of laparoscopic catheterization technology in peritoneal dialysis (PD) patients has recently increased. However, the advantages and disadvantages of laparoscopic versus conventional open PD catheter placement are still controversial. The aim of this meta-analysis is to assess the complications of catheterization in PD patients and to provide a reference for choosing a PD-catheter placement technique in the clinic.Methods: We searched numerous databases, including Embase, PubMed, CNKI and the Cochrane Library, for published randomized controlled trials (RCTs).Results: Eight relevant studies (n=646) were included in the meta-analysis. The pooled results showed a lower incidence of catheter migration (OR: 0.42, 95% CI: 0.19 to 0.90, P: 0.03) and catheter removal (OR: 0.41, 95% CI: 0.21 to 0.79, P: 0.008) but a higher incidence of bleeding (OR: 3.25, 95% CI: 1.18 to 8.97, P: 0.02) with a laparoscopic approach than with a conventional approach. There was no significant difference in the incidence of omentum adhesion (OR: 0.32, 95% CI: 0.05 to 2.10, P: 0.24), hernia (OR: 0.38, 95% CI: 0.09 to 1.68, P: 0.20), leakage (OR: 0.69, 95% CI: 0.38 to 1.26, P: 0.23), intestinal obstruction (OR: 0.96, 95% CI: 0.48 to 1.91, P: 0.90) or perforation (OR: 0.95, 95% CI: 0.06 to 15.42, P: 0.97). The statistical analysis showed no significant difference in early (OR: 0.44, 95% CI: 0.15 to 1.33, P: 0.15) , late (OR: 0.89, 95% CI: 0.41 to 1.90, P: 0.76) or total (OR: 0.68, 95% CI: 0.42 to 1.12, P: 0.13) peritonitis infections between the 2 groups, and there are no no significant difference in early ( OR: 0.39, 95% CI: 0.06 to 2.36, P: 0.30), late ( OR: 1.35, 95% CI: 0.78 to 2.33, P: 0.16) or total ( OR: 1.20, 95% CI: 0.71 to 2.02, P: 0.17) tunnel or exit-site infections between the 2 groups.Conclusion: Laparoscopic catheterization and conventional open catheter placement in PD patients have unique advantages, but laparoscopic PD catheterization may be superior to conventional open catheter placement. However, this conclusion needs to be confirmed with further large-sample-size, multi-centre, high-quality RCTs.

scholarly journals Review of Pro- and/or Prebiotics in Extensively Hydrolyzed or Amino Acid-Based Infant Formula for Food Allergy

2017 ◽  
Vol 11 (1) ◽  
pp. 27-38
Author(s):  
Nichole Giardina ◽  
Barbara Marriage
Keyword(s):  
Food Allergy ◽  
Amino Acid ◽  
Randomized Controlled Trials ◽  
Inflammatory Responses ◽  
The United States ◽  
Health Concern ◽  
Current Evidence ◽  
Controlled Trials ◽  
Advantages And Disadvantages ◽  
Randomized Controlled

Background:The incidence of food allergy is a growing health concern in the United States. Research suggests that there is a link between the gut microbiota and the development of allergy. As a result, researchers propose that gut microbial populations could affect the development and management of immunological disease.Objectives:The purpose of this review is to present current evidence of the advantages and disadvantages of probiotic and/or prebiotic addition to extensively hydrolyzed protein (EHF) and amino acid-based infant formulas (AAF) for the management of food allergy.Method:Only randomized controlled trials were included for review. The randomized controlled trials were limited to human subjects less than 12 years of age with a confirmed case of food allergy who were consuming EHF or AAF supplemented with probiotics and/or prebiotics.Results:Eleven studies were included for review. Probiotic and synbiotic addition was associated with an improvement in SCORAD index in EHF and AAF, and EHF significantly moderated immunologic and/or inflammatory responses. Probiotic addition to EHF benefited patients exhibiting hematochezia, and synbiotic addition resulted in softer stool, higher stool frequency, and decreased incidence of infection in some studies.Conclusion:Although few studies report statistically significant effects upon feeding prebiotics or probiotics with EHF and AAF on food allergy, this review sheds light on evidence that such inclusion may have positive impacts on SCORAD index, stool quality, immunologic and inflammatory factors, and incidence of infection.

scholarly journals Classic Chinese Acupuncture versus Different Types of Control Groups for the Treatment of Chronic Pain: Review of Randomized Controlled Trials (2000–2018)

2019 ◽  
Vol 2019 ◽  
pp. 1-15
Author(s):  
Yan-Jiao Chen ◽  
Gabriel Shimizu Bassi ◽  
Yong-Qing Yang
Keyword(s):  
Chronic Pain ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Control Groups ◽  
Chinese Acupuncture ◽  
Randomized Controlled ◽  
Different Types ◽  
Better Than

Objective. To review the effectiveness of classic Chinese acupuncture in the treatment of chronic pain by comparing treatment groups with different types of control groups in accordance with the newly published guidelines for systematic reviews. Methods. We searched EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials databases from 2000 to 2018. We included randomized controlled trials that included acupuncture as the sole treatment or as an adjunctive treatment for chronic pain. The outcome was pain intensity measured by the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, 11-point numeric rating scale (NRS), and other tools. Two researchers conducted the study selection, data extraction, and quality assessment processes independently. Disagreements were solved by discussion and reanalysis of the data. The quality of all included studies was evaluated using the CBNG (the Cochrane Back and Neck Group) and the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) checklists. Results. Sixty-one studies were fully analyzed and ranked based on the newest STRICTA and CBNG standards. We found good evidence that receiving acupuncture is better than not receiving treatment or being placed on a waiting list and reasonable evidence that it is better than conventional or usual care. Limited evidence was found regarding placebo treatments that involve the expectation of needling (real or fake). Conclusion. Sham acupuncture may not be appropriate as a control intervention for assessing the effectiveness of acupuncture. Acupuncture effectiveness in controlling chronic pain is still limited due to the low quality of the studies published.

Sign in / Sign up

Export Citation Format

Share Document