Journal of pediatric surgery
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Review Meta Analysis
Systematic review and meta-analysis of single-incision versus conventional laparoscopic appendectomy in children.
Increasing evidence has indicated that single-incision laparoscopic appendectomy (SILA) is a safe procedure that has a comparable clinical outcome to conventional multiport laparoscopic appendectomy (CLA) in adult patients. Nevertheless, the use of SILA in pediatric patients is still controversial, and systematic reviews that compare SILA and CLA in children are lacking in the current literature. ⋯ SILA seems to be a relatively feasible and safe procedure without any superiority to CLA. Thus, SILA may not be a better approach for pediatric patients.
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Review Meta Analysis
Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis.
The minimally invasive pectus excavatum repair (MIPER) is a painful procedure. The ideal approach to postoperative analgesia is debated. We performed a systematic review and meta-analysis to assess the efficacy and safety of epidural analgesia compared to intravenous Patient Controlled Analgesia (PCA) following MIPER. ⋯ Epidural analgesia may provide superior pain control but was comparable with PCA for secondary outcomes. Better designed studies are needed. Currently the analgesic technique should be based on patient preference and institutional resources.
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Review Meta Analysis
A systematic review and meta-analysis of caudal blockade versus alternative analgesic strategies for pediatric inguinal hernia repair.
The optimal analgesic strategy for pediatric inguinal hernia repair (IHR) remains undefined. We evaluated the available evidence comparing caudal blockade to alternative analgesic strategies in achieving post-operative analgesia. ⋯ There is no demonstrable difference in post-operative pain scores or rescue analgesia when comparing caudal blockade with alternative pain management strategies after pediatric IHR. This equipoise suggests that caudal blockade may be obviated for lower risk and less time-consuming maneuvers in patients barring supplementary indications for pain control.
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Necrotizing enterocolitis (NEC) is the most common acquired disease of the gastrointestinal tract in preterm infants, whereas probiotic supplementation might reduce NEC risk and potentially provide benefits to preterm infants. We performed an updated meta-analysis of all relevant randomized, controlled trials to assess the benefits of probiotic supplementation for preterm very low-birth-weight (VLBW) infants. ⋯ Probiotic supplement can reduce risk of NEC and mortality in preterm VLBW infants. However, the optimum type of probiotic supplement and the long-term effects need further study.
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Review Meta Analysis
Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis.
The objective of the study was to obtain the best estimates of the test performance of abdominal ultrasonography (US) for identifying children with intraabdominal injuries (IAIs). ⋯ Abdominal US has a modest sensitivity for the detection of children with hemoperitoneum; however, its test performance characteristics worsen when only the most methodologically rigorous articles are included. A negative US examination has questionable utility as the sole diagnostic test to rule out the presence of IAI. Because of the high risk of IAI, a hemodynamically stable child with a positive US examination should immediately undergo abdominal computed tomographic scanning.