Comparison of efficacy and safety of four surgical approaches for acute appendicitis in children: A systematic review and network meta-analysis of randomized clinical trials

摘要

Acute appendicitis is one of the most common pediatric emer- gencies. 1 Children with acute appendicitis are mainly managed by surgical treatment. The primary aim of this study is to compare the efficacy and safety of four surgical approaches, appendectomy (OA), conventional laparoscopic appendectomy (CLA), open single incision laparoscopic appendectomy (SILA), and small access ap- pendectomy (SAA) for acute appendicitis in children. The PubMed, EMBASE, and Cochrane Library databases were systematically searched up to October 2020. Only randomized controlled trials (RCTs) Comparing at least 2 of the four surgical approaches for acute appendicitis in children were included. Two independent re- viewers assessed the trials for eligibility and quality and extracted data. The Cochrane risk of bias tool and CINeMA were applied for assessing quality of included studies and certainty of evidence. The direct statistical analyses were conducted using Stata 14.0 and the network meta-analysis (NMA) were performed by using ADDIS 1.16.18. To our knowledge, the present systematic review based on RCTs is the first to compare the four approaches available for the treatment of acute appendicitis in children by using a network meta-analysis.