ArticleWorld journal of gastrointestinal surgery2025
Effectiveness of different appendiceal stump closure methods in laparoscopic appendectomy in children: A systematic review and network meta-analysis.
Article in World journal of gastrointestinal surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- Efficacy and safety of ERAS protocols in pediatric laparoscopic appendectomy: a systematic review and meta-analysis.Frontiers in pediatrics · 2026Pooled it
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLaparoscopic appendectomy (LA) is the standard treatment for acute appendicitis in children, offering reduced postoperative pain and quicker recovery compared to open surgery. A critical aspect of LA is the secure closure of the appendiceal stump to avoid complications such as leakage and abscess formation. Various closure techniques are employed, including endoloops (ELs), staplers, clips, and energy devices; however, the optimal method remains unclear due to inconsistent evidence.
aimTo systematically evaluate and rank the effectiveness and safety of different appendiceal stump closure techniques used in pediatric LA. By assessing outcomes such as postoperative complications, operative time, and length of hospital stay, this analysis seeks to provide evidence-based guidance to clarify clinical decision-making and optimize patient care.
methodsThis systematic review and network meta-analysis, conducted according to PRISMA and Cochrane guidelines, compared the effectiveness and safety of stump closure methods in pediatric LA. Databases searched included PubMed, Cochrane Central, Web of Science, and Scopus up to May 1, 2025. Eligible studies included both randomized and non-randomized designs reporting surgical outcomes in pediatric patients. Two reviewers independently extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. A frequentist network meta-analysis with a random-effects model was conducted using R software to evaluate total complications (primary outcome), as well as operative time and hospital stay (secondary outcomes).
resultsFourteen studies comprising over 50000 pediatric patients were included in the network meta-analysis comparing appendiceal stump closure techniques in LA. No significant differences in total postoperative complications or hospital stay were observed among techniques, including EL, endostapler, polymer clip, LigaSure, harmonic scalpel (HS), and sutures. HS showed a statistically significant reduction in operative time compared to EL (mean difference: -13.5 minutes), while other methods did not demonstrate significant time savings. No technique was associated with a statistically significant increase or decrease in postoperative complications or length of stay. Publication bias was minimal, and the methodological quality of included studies was moderate to good.
conclusionWhile all closure techniques show similar safety profiles, HS offers shorter operating times. These findings support tailoring stump closure method selection based on operative efficiency and resource availability.
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