Evaluating surgical strategies for pediatric congenital choledochal cysts: a multicenter retrospective study and network meta-analysis
Bibliographic record
Abstract
Objective This study compared the efficacy and safety of open, laparoscopic, and robotic-assisted surgeries for pediatric congenital choledochal cysts (CCC) using network meta-analysis, with retrospective cohort data to validate findings. Methods Following the PRISMA guidelines, 28 cohort studies involving a total of 3,672 patients were included. Key outcomes assessed included operative time, hospital stay, intraoperative blood loss, postoperative bile leakage rate, and postoperative bowel obstruction rate. A Bayesian model was employed for the network meta-analysis, with heterogeneity and consistency checks as well as publication bias assessments. Furthermore, a retrospective cohort study was conducted on 72 CCC patients who underwent surgery between January 2010 and January 2025 at two medical centers [60 cases in the open surgery group [OSG] and 12 cases in the laparoscopic surgery group [LSG]]. These data were incorporated into the meta-analysis to evaluate consistency with prior findings. Results The 28 studies (2007–2025) included two three-arm and 26 two-arm studies. Newcastle-Ottawa Scale assessment identified biases in selection and follow-up in some studies. Open surgery had the shortest operative time (MD = −1.101 vs. laparoscopic, 95% CI: −1.368 to −0.834; MD = −1.39 vs. robotic, 95% CI: −1.69 to −1.09), followed by robotic-assisted, then laparoscopic surgery. Robotic-assisted surgery had the shortest hospital stay (MD = −1.98 vs. open, 95% CI: −2.72 to −1.19), followed by laparoscopic. Laparoscopic surgery had the least blood loss (MD = 46.76 vs. open, 95% CI: 10.36–83.64), followed by robotic-assisted. Robotic-assisted surgery had the lowest bile leakage rate; laparoscopic had the lowest bowel obstruction rate (OR = 0.11 vs. open, 95% CI: 0.01–0.6). Retrospective data showed OSG had shorter operative time (3.52 ± 0.82 vs. 5.61 ± 1.24 h, P < 0.01), longer hospital stays (15.98 ± 4.99 vs. 12.92 ± 2.15 days, P < 0.05), and greater blood loss (90.45 ± 62.29 vs. 46.00 ± 26.52 ml, P < 0.05) than LSG, with no significant difference in complications. Updated meta-analysis confirmed consistent rankings. Conclusions Robotic-assisted surgery excels in reducing hospital stay and bile leakage, laparoscopic surgery minimizes blood loss and bowel obstruction, while open surgery is fastest but inferior in other outcomes. These findings guide CCC surgical decisions, though randomized trials are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.035 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.029 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".