Introduction Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. We reviewed the literature on studies published in the last three decades and dealing with advantages and disadvantages of laparoscopy compared to open surgery.

Materials and Methods Studies comparing laparoscopic versus open abdominal procedures in children were searched in PubMed/MEDLINE. Reports on upper and lower gastrointestinal as hepatobiliary surgery and on surgery of pancreas and spleen were included. Advantages and disadvantages of laparoscopic surgery were analyzed for different types of procedures. Complications were categorized using the Clavien–Dindo classification.

Results A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien–Dindo grade I to III complications (mild–moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency of reporting on advantages after laparoscopy and increased reporting on disadvantages for all surgery types over the decades.

Conclusion Laparoscopic compared with open pediatric surgery seems to be beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.

引言 尽管腹腔镜手术被广泛接受，但腹腔镜手术相对于开放式儿科手术的优越性仍然存在争议。仍然需要有充分根据的证据。我们回顾了过去三十年发表的研究文献，并讨论了腹腔镜手术与开腹手术相比的优缺点。

材料和方法 在 PubMed/MEDLINE 中搜索了比较儿童腹腔镜手术与开腹手术的研究。包括关于上消化道和下消化道作为肝胆手术和胰腺和脾脏手术的报告。针对不同类型的手术分析了腹腔镜手术的优缺点。使用 Clavien-Dindo 分类对并发症进行分类。

结果 共分析了 239 项研究，涉及 929,157 名患者的 19 种程序和结果。我们确定了 26 项随机对照试验 (10.8%) 和 213 项比较研究 (89.2%)。在 60.4% 的研究中，腹腔镜检查最常报告的优势是住院时间更短。在 52.7% 的研究中，较长的手术时间是腹腔镜检查最常报告的缺点。与开腹手术相比（80.3% 的研究），在腹腔镜下发现 Clavien-Dindo I 至 III 级并发症（轻度至中度）的频率较低。腹腔镜与开腹阑尾切除术治疗穿孔性阑尾炎相比，IV 级并发症（严重）的报道较少，而在腹腔镜 Kasai 的门肠造口术后报道较多。

结论 与开放式儿科手术相比，腹腔镜在大多数类型的手术中似乎是有益的。随机对照试验（RCT）的数量仍然有限。然而，在过去几十年中，关于劣势的报告数量有所增加。