S2130 Comparison of Trans Umbilical Laparoscopic-Assisted Appendectomy (TULAA) vs Conventional Laparoscopic Appendectomy (CLA) In the Pediatric Population: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Introduction: Appendicitis, a pediatric emergency, is usually managed with conventional 3-port laparoscopic appendectomy (CLA). Trans-umbilical extracorporeal laparoscopic assisted appendectomy (TULAA) offers a novel approach, matching CLA's benefits while enhancing cosmetic results. This study evaluates the safety and efficacy of TULAA compared to CLA in children to identify the optimal surgical method. Methods: We searched PubMed, Cochrane Library (CENTRAL), ScienceDirect, and ClinicalTrials.gov databases from inception to May 2024. Studies comparing outcomes of TULAA and conventional laparoscopic appendectomy in pediatric patients aged 0-18 years were included. We used RevMan 5.4.1 software to combine mean differences (MD) and risk ratios (RR) for continuous and dichotomous outcomes, respectively, with a 95% confidence interval (CI) using the random effects model. Sensitivity analysis was conducted for outcomes with heterogeneity exceeding I2 = 50%. Quality assessment was done using the Newcastle-Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool (Rob 2.0) and the risk of publication bias in the included studies was assessed through funnel plots and Egger’s regression test. Results: A total of 16 studies, 1 randomized controlled trial and 15 retrospective cohort studies with 5,084 patients were included in this meta-analysis (Table 1). TULAA was significantly superior to CLA in terms of operating time (OT) (MD = -11.16 min, 95% CI: [-14.84, -7.47]; P = 0.00001; I2 = 95%), length of hospital stay (LOS) (MD = -0.44 days, 95% CI: [-0.71, -0.17]; P=0.002; I2 = 91%), and intraabdominal infections (RR = 0.64, 95% CI: [0.43,0.96]; P = 0.03; I2 = 0%). TULAA was also associated withan increased requirement of additional ports (RR= 32.22, 95% CI: [10.11,102.70]; P= 0.00001; I2 = 0%) while the 2 groups were comparable in terms of wound infection (RR = 1.11, 95% CI: [0.68,1.79]; P = 0.68; I2 = 12%), ileus (RR = 0.71, 95% CI: [0.33,1.53]; P = 0.38; I2 = 0%), conversion rate to open appendectomy (RR= 2.77, 95% CI: [0.86,8.89]; P = 0.09, I2 = 77%) and readmission rate (RR= 0.73, 95% CI: [0.33,1.61]; P = 0.43; I2 = 33%) (Figure 1). Conclusion: TULAA shows promising results in treating pediatric appendicitis. TULAA outperformed CLA in terms of operating time, length of hospital stays, and intraabdominal infection. There was no significant difference in terms of wound infection, ileus, conversion rate and readmission between the 2 groups.Figure 1.: A. Operating time. B. Length of hospital stay. C. Wound infection D. Intra abdominal infections (abscess). Table 1. - Studies included Author Study Design Duration (year, month) Participants Country Mean age in years(SD) Gender, n (M/F) Weight or BMI kg/m2 (SD) Complicated appendicits n%(TULAA/CLA) NOS TULA CLA TULA CLA Go 2016 RC (4,0) 303 Korea 9.02(2.28) 9.64(2.14) 187/116 - - 0/0 8 Stanfill 2010 RC (2,11) 131 United States 10.45(0.65) 11.51(0.93) 88/43 - - 11/14 8 Sekioka 2018 RC (9,0) 262 - 10.6(4.6-16.3)* 10.1(3.2-15)* 88/33 32.2(14-62) 33.3(14.2-58.7) 81/60 7 Nishida 2024 RC (6,8) 225 Japan 10.1(2.8) 9.9(2.6) 133/92 34.4(13) 34.4(12.8) 33/28 8 Kulyalat 2014 RC (2,10) 433 United States 9.4(3.3) 10.1(3.8) 230/142 - - 13/55 7 Chang 2020 RC (4,5) 315 Taiwan 11.8(3.4) 10.5(4.3) 101/53 - - 12/62 8 Deie 2013 RC (3,4) 88 - 10.3(2.6) 10.5(2.76) 55/33 32.3(9.75) 33.7(11.3) 31/44 6 Karam 2016 RC (5,11) 625 - 10.63(3.7) 11(3.2) 389/236 52.15(24.42) 65.09(20) 46/122 6 Rebecca 2023 RC (5,2) 1154 United States 10.3(3.5) 11.2(3.7) 724/430 19.2(4.1) 21.4(6.1) 0/0 8 Bindi 2023 RC (1,11) 181 - 10.7(0.6) 9.2(0.4) - 36.2(1.5) 32.9(1.8) 136/79 7 Bergholz 2014 RC - 20 Germany 12.42(10.13-14.11)* 12.93(11.25-14.62)* 8/32 - - 2/4 8 Wieck 2016 RC (5,0) 337 Portland 10(4.1) 10.2(3.8) 192/145 19.3(4.4) 20(1.1) 40/80 7 Martin 2017 RC (12,3) 460 Spain 122.8(35.8) 123(33.9) 294/166 39.4(29.7) 37.6(16.5) 136/9 7 Vejdan 2021 RCT (1,4) 210 Iran 12.32(2.14) 11.43.32(2.76) 73/67 17.35(3.12) 17.92(2.43) 0/0 Low* Visnijic 2007 RC (3,0) 72 Croatia - - - - - 0/0 8 He 2022 RC (3,9) 268 China 11.3(3.4) 10.6(3.2) 129/139 16.5(2.2) 16.8(2) 0/0 8 CLA, conventional laproscopic appendectomy; NOS, Newcastle-Ottawa Scale; RC, retrospective cohort; RCT: randomized control trial; TULA, transumbilical laproscopic assisted appendectomy.*median(range).**ROB 2.0 assessment.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,014 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
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score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
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