***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of the study was to evaluate the efficacy of endosurgery for generalized appendiceal peritonitis in children .  Laparoscopic appendectomy ( LA ) was used as a procedure of choice in all forms of peritonitis and its complications . Original three-trocar approach and modified Gotz technique were applied . From 1991 to 2002 LA was performed in 4024 children aged from 7 days to 16 years , in 298 ( 5.8 % ) patients generalized peritonitis was diagnosed current . Prospect i ve comparative r and omized study includes 200 patients with generalized appendicular peritonitis . Contraindications were in 7 % cases , rate of conversion to open surgery--2.1 % . Duration of surgery was 61.7 + /- 24 min in laparoscopic group ( LG ) vs 73.2 + /- 31 min in open surgery group ( OG ) . Patients of LG demonstrated earlier repair of many functions . There were no lethal outcomes . Rate of minor surgical complications was 10 % in LG and 21 % in OG ( p < 0.05 ) , major complications--13 and 16 % ( p = 0.55 ) , respectively . There was no difference in rate of abscess formation ( 4 % ) . Rate of pneumonia was 1 % in LG and 3 % in OG ( p < 0.05 ) , rate of critical conditions--2 and 4 % ( p = 0.067 ) . Hospital stay was 15.7 + /- 3.1 days in LG and 21.2 + /- 3.8 days in OG . It is concluded that laparoscopic approach could be successfully used in more than 90 % cases of generalized appendicular peritonitis . Endosurgery has many advantages over open surgery . LA demonstrates the best benefits in generalized peritonitis OBJECTIVE . The role of laparoscopic surgery in pediatric inguinal hernia repair is unclear . We aim ed to compare day-case laparoscopic hernia repair with open repair . METHODS . A prospect i ve , single-blinded r and omized study in children aged 4 months to 16 years with unilateral inguinal hernia was performed . The primary outcome measure was the time to normal daily activities after surgery . Secondary outcome measures included postoperative pain , time in the operation room , results , and complications . RESULTS . Eighty-nine patients were enrolled ( laparoscopic hernia repair : 47 , open repair : 42 ) . The mean number of days to normal activity after laparoscopic hernia repair and open repair was 2.4 and 2.5 , respectively . Thirty-seven ( 79 % ) patients with laparoscopic hernia repair and 20 ( 42 % ) with open repair required rescue analgesia postoperatively . The median pain score in the second postoperative morning was significantly higher after laparoscopic hernia repair . The median times in the operation room for laparoscopic hernia repair and open repair were 63 and 38 minutes , respectively . Surgical and cosmetic results were similar at up to 2 years ' follow-up . CONCLUSIONS . Recovery and outcome were similar after open repair and laparoscopic hernia repair in children .  Laparoscopic hernia repair was associated with increased theater time and postoperative pain Although laparoscopic procedures are currently in vogue in general surgery , the role of this approach in children has not been prospect ively evaluated in the United States using the new instrumentation now available to us . To assess the value of laparoscopic appendectomy ( LA )  in childhood , we prospect ively compared 14 LAs with 50 open appendectomies ( OA ) over 6 months in a single children 's hospital . Antibiotic usage was at the discretion of the surgeon regardless of the procedure performed and was not different between groups . LA was performed under the direction of a single laparoscopy-trained surgeon and patient selection was based on parental consent . A three-puncture LA technique was used ; children from this group were allowed to return to full activities as soon as they were comfortable . There were no significant differences between groups for severity of disease , age , weight , hospital cost , or complications . The types of complications that developed were comparable in both groups . The percent of complicated appendicitis ( gangrene or perforation ) was 32 % in the OA group and 36 % in the LA group . Patients in the LA group spent significantly fewer days in the hospital and returned to unrestricted activities ( school , athletics , etc ) faster than patients in the OA group . LA is approximately $ 1,000 more expensive than OA , the differences being easily explainable by the cost of the disposable supplies necessary for the procedure ( laser fibers , trocars , etc ) , but because of the shorter hospital stay in the LA group the mean total cost for each group was comparable . These data suggest that although there appears to be no cost advantage , LA shortens the hospital stay and allows children to return to unrestricted activity sooner than OA . ( ABSTRACT TRUNCATED AT 250 WORDS Background : The aim of this study was to evaluate prospect ively whether laparoscopic ( LA ) and open appendectomy ( OA ) are equally safe and feasible in the treatment of pediatric appendicitis . Methods : A total of 517 children with acute appendicitis were r and omly assigned to undergo LA or OA appendectomy , based on the schedule of the attending surgeon on call . Patient age , sex , postoperative diagnosis , operating time , level of training of surgical resident , length of postoperative hospitalization , and minor and major postoperative complications were recorded . Chi-square analysis and the Student t-test were used for statistical analysis . Results : In all , 376 OA and 141 LA were performed . The two groups were comparable in terms of patient demographics and the incidence of perforated appendicitis . The operative time was also similar ( 47.3 ± 19.7 vs 49.9 ± 12.9 min ) . The overall incidence of minor or major complications was 11.2 % in the OA group and 9.9 % in the LA group . Conclusion : Pediatric patients with appendicitis can safely be offered laparoscopic appendectomy without incurring a greater risk for complications . Nevertheless , a higher ( but not significantly higher ) abscess rate was found in patients with perforated appendicitis who underwent laparoscopy Over a period of 6 months , 48 children who underwent conventional appendectomy ( CA ) were compared to 34 children who had laparoscopic appendectomy ( LA ) for acute and recurrent subacute appendicitis . Their ages ranged from 4 to 12 years ( mean 8) .  LA took significantly longer , 76 min , versus 50 min for CA . Less than 2 days ’ hospitalization was required in 95 % of LA cases and 45 % of CA cases . Time to return to normal activity averaged 7 days for LA and 12 days for CA ( P < 0.001 ) . Wound complications were fewer and the cosmetic appearance was most satisfactory in LA patients . LA is a safe operation that has the advantage of being exploratory , with shorter hospitalization time , early ambulation , and superior cosmetic results Background and Objectives : Herniotomy/open surgery ( OS ) has been the time honored treatment for pediatric inguinal hernia ( PIH ) .  Laparoscopic surgery ( LS ) has recently emerged as an alternative in its management . However , controversy is rife on its feasibility and wider adoption . The present need is to know whether a significant difference exists in the surgical outcomes following either technique . Methods : In a prospect i ve study between January and December 2006 , 85 children underwent either LS ( 51 ) or OS ( 34 ) for PIH .  Operation time , intra- and postoperative complications , postoperative pain , postoperative stay , cosmesis , and the size of testis were recorded and compared for differences in outcome . Patients were followed up for an average of 3.5 months . Results : All in the open group had unilateral ( UL ) hernias . The laparoscopy group had 6 ( 11.8 % ) bilateral ( BL ) hernias , and 10 ( 22.2 % ) contralateral patencies of processus vaginalis ( CPPV ) were detected intraoperatively and repaired simultaneously . Bilateral repairs were excluded from comparative analysis . LS was slightly quicker than OS to perform [ 25.31 min vs 30.65 min ( P=0.06 ) ] . The difference in pain perception , between LS and OS , was insignificant . Immediate postoperative recovery was delayed in more children undergoing LS ( P=0.02 ) , but the duration of hospital stay was similar ( P=0.37 ) . Complication rates were similar ( P=0.96 ) . Cosmesis in LS was superior to that in OS . Conclusions : Well-performed conventional herniotomy yields results similar to those of laparoscopic repair . Cosmesis and the ability to detect and simultaneously repair CPPV are the 2 main advantages of LS over OS . Keeping in mind the low incidence of meta-chronicity in UL hernias , in significance of cosmesis over the groin , and the constraints of the developing world , conventional open herniotomy can justly be performed for UL hernias , as the st and ard of care , in centers lacking laparoscopy Background The repair of indirect inguinal hernia ( IH ) is one of the most common pediatric surgical procedures , and open surgery ( OS ) is the st and ard treatment . The aim of this study was to determine whether the recently developed laparoscopic repair ( LR ) of IH is superior to OS . Methods Between February 2003 and February 2004 , we r and omly assigned 97 consecutive IH patients at our institution into OS and LR groups . Fourteen pateints were excluded from the study for various reasons , leaving study population of 83 patients . After operation , multiple dressings were placed to blind observers to the operation type . Two pain scales , the children and Infants Postoperative Pain were used to assess postoperative pain .  Acetaminophen ( 15 mg/kg/dose every 6 h ) was given at a fixed pain score . Analgesic doses were compared . Parents also provided assessment s of their children ’s recovery and wound appearance . Results The amount of acetaminophen  taken by the OS group ( n = 42 ) was 1.05 ± 1.248 doses per patient , whereas the amount taken by the LR group ( n = 41 ) was 0.54 ± 0.84 dose per patient ( p = 0.032 ; 95 % confidence interval 0.45–0.976 ) . Laparoscopy detected 11 more bilateral hernias ( p = 0.006 ) . Although the operative times did not differ significantly for bilateral hernias ( 39.08 ± 13.37 min vs 34.0 ± 11.31 min , p = 0.623 ) , it did differ for unilateral hernias ( 18.38 ± 5.71 vs 23.25 ± 6.26 min , p = 0.001 ) . Five contralateral hernias were detected in the OS group on follow-up , but none were found in the LR group ( p = 0.026 ) . The scores given by parents for recovery and wound appearance were higher in the LR group ( p = 0.05 ) . Conclusions As compared with IH patients who undergo open surgery , those who have a laparoscopic repair suffer less pain , and their recovery and wound cosmesis are more satisfactory . With LR , contralateral hernias can be detected and repaired in a single operative procedure . This procedure takes slightly longer for unilateral than for bilateral hernias Aims : The purpose of this study was to compare open versus laparoscopic appendicectomy ( LA ) in complicated appendicitis . Material s and Methods : We prospect ively analyzed all children over a 2-year period who underwent appendicectomy in a single institution and found 30 cases of complicated appendicitis diagnosed on the table and confirmed by histopathology . These children were allocated r and omly into Group 1 if they had LA and Group 2 if they had open appendicectomy ( OA ) , solely based on surgeon assessment . The parameters assessed were duration of symptoms before surgery , use of postoperative parenteral analgesia , timing of initiation of feeds after surgery , postoperative complications and duration of postoperative stay . Results : Of the 30 patients with complicated appendicitis , 12 patients in Group 1 underwent LA and 18 patients in Group 2 underwent OA . The two groups were comparable for age and sex . Children in Group 1 were found to need less parenteral analgesia ( two out of 12 versus six out of 18 ) . Postoperatively , feeds were started earlier in Group 1 than in Group 2 ( 2.5 days versus 3.7 days ) . The average postoperative hospital stay was 5 days in Group 1 and 7.5 days in Group 2 . There were only minor wound infections in Group1 as against two major complications in Group 2 . There was no mortality in either group . Conclusions : In complicated appendicitis , laparoscopic approach carries definite advantages with less postoperative morbidity and hospital stay . It is a feasible and better alternative than the open approach in complicated appendicitis Background The laparoscopic approach has become increasingly popular for fundoplication over the last few years ; however many surgeons are skeptical about its real advantages . Methods We conducted a prospect i ve comparative study of children operated on for gastroesophageal reflux ( GER ) . Exclusion criteria included age < 1 year and > 14 years , previous surgery on the esophagus or stomach , and neurologic impairment . We compared two groups 
    Output:
    
Total hospital costs of the laparoscopic approaches were found to be insignificantly increased compared to the open techniques .
This review further supports the use of minimally invasive surgery ( MIS ) in pediatric population s , demonstrating that the three types laparoscopic procedures review ed result ed in better patient outcomes compared to open procedures , in the form of reduced LOS and overall complication rates .
Increased utilization of this approach may prove beneficial to pediatric patients