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Laparoscopy in pediatric surgery: implementation in Canada and supporting evidence

Sattarova, V; Eaton, S; Hall, NJ; Lapidus-Krol, E; Zani, A; Pierro, A; (2016) Laparoscopy in pediatric surgery: implementation in Canada and supporting evidence. Journal of Pediatric Surgery , 51 (5) pp. 822-827. 10.1016/j.jpedsurg.2016.02.030. Green open access

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Abstract

BACKGROUND/PURPOSE: The purpose of this study was to assess the diffusion of laparoscopy usage in Canadian pediatric centers and the relationship between uptake of laparoscopic surgery and the level of evidence supporting its use. METHODS: National data on four pediatric laparoscopic operations (appendectomy, pyloromyotomy, cholecystectomy, splenectomy) were analyzed using the Canadian Institute for Health Information Discharge Database (2002-2013). The highest level of evidence to support the use of each procedure was identified from Cochrane, Embase, and Pubmed databases. Chi-square test for trend was used to determine significance and time to plateau. RESULTS: There were 28,843 operations (open: 12,048; laparoscopic: 16,795). Use of laparoscopic procedures increased over time (p<0.0001). A plateau was reached for cholecystectomy (2006), splenectomy (2007), and appendectomy (2012), but not for pyloromyotomy. Laparoscopic pyloromyotomy in 2013 remains less diffused than the other procedures (p<0.0001). Laparoscopic appendectomy and pyloromyotomy are supported by level-1a evidence in children, whereas cholecystectomy and splenectomy are supported by level-1a evidence in adults but level-3 in children. CONCLUSIONS: In Canada, it has taken a long time to reach high-level implementation of laparoscopic surgery in children. Laparoscopic cholecystectomy first reached plateau, whereas laparoscopic pyloromyotomy continues to increase but remains low despite high level of evidence in support of its usage compared to open surgery.

Type: Article
Title: Laparoscopy in pediatric surgery: implementation in Canada and supporting evidence
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jpedsurg.2016.02.030
Publisher version: http://dx.doi.org/10.1016/j.jpedsurg.2016.02.030
Language: English
Additional information: Copyright © 2016 Published by Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Appendicitis, Children, Cholecystectomy, Laparoscopy, Minimally invasive surgery, Pediatric surgery, Pyloromyotomy, Splenectomy, Surgery
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Biology and Cancer Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1475892
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