1
|
Wang G, Liu Q, Chen G, Xia B, Zeng D, Chen G, Guo C. AI's deep dive into complex pediatric inguinal hernia issues: a challenge to traditional guidelines? Hernia 2023; 27:1587-1599. [PMID: 37843604 DOI: 10.1007/s10029-023-02900-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE This study utilized ChatGPT, an artificial intelligence program based on large language models, to explore controversial issues in pediatric inguinal hernia surgery and compare its responses with the guidelines of the European Association of Pediatric Surgeons (EUPSA). METHODS Six contentious issues raised by EUPSA were submitted to ChatGPT 4.0 for analysis, for which two independent responses were generated for each issue. These generated answers were subsequently compared with systematic reviews and guidelines. To ensure content accuracy and reliability, a content analysis was conducted, and expert evaluations were solicited for validation. Content analysis evaluated the consistency or discrepancy between ChatGPT 4.0's responses and the guidelines. An expert scoring method assess the quality, reliability, and applicability of responses. The TF-IDF model tested the stability and consistency of the two responses. RESULTS The responses generated by ChatGPT 4.0 were mostly consistent with the guidelines. However, some differences and contradictions were noted. The average quality score was 3.33, reliability score was 2.75, and applicability score was 3.46 (out of 5). The average similarity between the two responses was 0.72 (out of 1), Content analysis and expert ratings yielded consistent conclusions, enhancing the credibility of our research. CONCLUSION ChatGPT can provide valuable responses to clinical questions, but it has limitations and requires further improvement. It is recommended to combine ChatGPT with other reliable data sources to improve clinical practice and decision-making.
Collapse
Affiliation(s)
- G Wang
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Pediatrics, Children's Hospital, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatric General Surgery, Chongqing Maternal and Child Health Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Q Liu
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - G Chen
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - B Xia
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - D Zeng
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - G Chen
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China.
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
- Department of Pediatric General Surgery, Chongqing Maternal and Child Health Hospital, Chongqing Medical University, Chongqing, People's Republic of China.
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China.
| | - C Guo
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China.
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
- Department of Pediatric General Surgery, Chongqing Maternal and Child Health Hospital, Chongqing Medical University, Chongqing, People's Republic of China.
| |
Collapse
|
2
|
Tsai TJ, Lin CM, Cheang IN, Hsu YJ, Wei CH, Chin TW, Wu CY, Chang WY, Fu YW. Comparing Outcomes of Single-Incision Laparoscopic Herniorrhaphy in Newborns and Infants. Diagnostics (Basel) 2023; 13:diagnostics13030529. [PMID: 36766634 PMCID: PMC9914195 DOI: 10.3390/diagnostics13030529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND As surgical techniques progress, laparoscopic herniorrhaphy is now performed more often in premature babies. The aim of this study was to analyze the outcomes of newborns and infants who underwent single-incision laparoscopic herniorrhaphy (SILH) at our center. METHODS We retrospectively reviewed patients younger than 12 months old who received SILH at our department from 2016 to 2020. SILH involved a 5 mm 30-degree scope and 3 mm instruments with a 3-0 Silk purse-string intracorporeal suture for closure of the internal ring. At the time of surgery, Group 1 newborns, whose corrected age was 2 months and below, were compared to the Group 2 infants, whose age was above 2 months. We assessed the patients' characteristics, anesthesia, surgical data, and complications. RESULTS A total of 197 patients were included (114 newborns in Group 1 and 83 infants in Group 2). The mean age and body weight in Group 1 were 1.2 months and 3.8 kg, respectively, whereas in Group 2, they were 3.2 months and 6.7 kg, respectively. There were no significant differences in operative time (Group 1 = 34.1 min vs. Group 2 = 32.3 min, p = 0.26), anesthetic time (Group 1 = 80.0 min vs. Group 2 = 76.3 min, p = 0.07), length of hospitalization (Group 1 = 2.3 days vs. Group 2 = 2.4 days, p = 0.88), postoperative complications including omphalitis (Group 1 = 5.3% vs. Group 2 = 1.2%, p = 0.13), wound infection (Group 1 = 0.9% vs. Group 2 = 1.2%, p = 0.81), and hydrocele (Group 1 = 0.35% vs. Group 2 = 8.4%, p = 0.14). No recurrence, testicular ascent or atrophy, or mortality was observed in either group during the 2-year follow-up period. CONCLUSIONS Single-incision laparoscopic herniorrhaphy is a safe and effective operation for inguinal hernia repair in infants, even those with prematurity, lower body weight at the time of surgery, or cardiac and/or pulmonary comorbidities. Comparable results revealed no significant differences in perioperative complications despite younger ages and lower body weights.
Collapse
Affiliation(s)
- Tsung-Jung Tsai
- Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Ching-Min Lin
- Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - I Nok Cheang
- Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Yao-Jen Hsu
- Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Chin-Hun Wei
- Division of Pediatric Surgery, Department of Surgery, Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Tai-Wai Chin
- Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Chin-Yen Wu
- Department of Nursing, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Wen-Yuan Chang
- Department of Nursing, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Yu-Wei Fu
- Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
- Correspondence: ; Tel.: +886-4723-8595
| |
Collapse
|
3
|
Shaughnessy MP, Maassel NL, Yung N, Solomon DG, Cowles RA. Laparoscopy is increasingly used for pediatric inguinal hernia repair. J Pediatr Surg 2021; 56:2016-2021. [PMID: 33549307 DOI: 10.1016/j.jpedsurg.2021.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Inguinal hernia repairs (IHR) are commonly performed by pediatric surgeons in the United States. The operative approach depends on surgeon preference with no definitive prospective studies comparing laparoscopic inguinal hernia repair (LIHR) versus traditional inguinal hernia repair (TIHR). We aim to assess current practice, hypothesizing that laparoscopy is increasingly used for pediatric IHR. MATERIAL & METHODS The Children's Hospital Association (CHA) Pediatric Health Information System was queried for IHRs performed between 01/01/2009 and 12/31/2018. Demographics, procedure type, hernia laterality, and cost were obtained. Patients were grouped by procedure type (laparoscopic/traditional). RESULTS 125,249 IHRs were performed at 32 CHA hospitals during the ten-year study period. 115,782 (92.4%) were TIHR and 9467 (7.6%) LIHR. Use of laparoscopy increased 5-fold from 3% to 15% over the study period. When comparing laparoscopic to traditional IHR groups, there were more females (28.3% vs 12.6%), African-Americans (19.7% vs 14.4%), government-insured (50% vs 45.2%), younger patients (4.2 vs 4.4 years), bilateral IHRs (11.4% vs 7.9%), and higher adjusted total hospital cost ($3,791 vs $2995) in the laparoscopic group (p<0.0001, all comparisons). CONCLUSIONS Laparoscopy for pediatric IHR is increasing at CHA hospitals where nearly 1 in 6 children currently undergoes a laparoscopic repair. The long-term outcomes with laparoscopic repair are worthy of future study.
Collapse
Affiliation(s)
- Matthew P Shaughnessy
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Nathan L Maassel
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Nicholas Yung
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Daniel G Solomon
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Robert A Cowles
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States.
| |
Collapse
|
4
|
Comparison of Recurrence and Complication Rates Following Laparoscopic Inguinal Hernia Repair among Preterm versus Full-Term Newborns: A Systematic Review and Meta-Analysis. CHILDREN-BASEL 2021; 8:children8100853. [PMID: 34682118 PMCID: PMC8534929 DOI: 10.3390/children8100853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 01/20/2023]
Abstract
Background: Laparoscopic inguinal hernia repair (LHR) in children has been widely performed in the last decades, although it is still not sufficiently researched in preterm infants. This systematic review and meta-analysis compared the recurrence and complication rates following laparoscopic hernia repair among preterm (PT) versus full-term (FT) newborns. Methods: Scientific databases (PubMed, EMBASE, Scopus, and Web of Science databases) were systematically searched for relevant articles. The following terms were used: (laparoscopic hernia repair) AND (preterm). The inclusion criteria were all preterm newborns with a unilateral or bilateral inguinal hernia who underwent LHR. The main outcomes were the incidence of recurrence of hernia and the proportion of children developing postoperative complications in comparison with FT newborns following LHR. Results: The present meta-analysis included four comparative studies. Three studies had a retrospective study design while one was a prospective study. A total of 1702 children were included (PT n = 523, FT n = 1179). The incidence of hernia recurrence showed no significant difference between the PT versus FT groups (RR = 2.58, 95% CI 0.89–7.47, p = 0.08). A significantly higher incidence of complications was observed in the PT group compared to the FT group (RR = 4.05, 95% CI 2.11–7.77, p < 0.0001). The PT group of newborns accounted for 81% and 72% of the major and minor complications. The major complications were either non-surgical (i.e., severe respiratory distress requiring reintubation with prolonged ventilation (or high-frequency ventilation), seizures, bradycardia), or surgical (i.e., hydroceles requiring operative intervention and umbilical port-site hernia). Conclusions: LHR in PT infants is associated with similar recurrence rates as in FT infants. However, the incidence of complications is significantly higher in PT versus FT infants.
Collapse
|
5
|
Abstract
Inguinal hernia is a common problem affecting infants in the NICU. As a group, preterm infants have the highest incidence of inguinal hernia and this risk increases as gestational age decreases. The etiopathologic factors leading to the development of an inguinal hernia are not clear and interventions to alter these factors have not been thoroughly investigated. Diagnosis of an inguinal hernia is often straightforward, but occasionally it may be difficult to determine if the hernia is strangulated or simply obstructed. Rarely, investigative modalities, such as ultrasonography, may be needed to rule out other potential causes. The ideal timing of surgical repair in this population is unknown and complicated by comorbid conditions and limited randomized controlled trials. During surgery, the choice of regional versus general anesthesia requires a team-based approach and studies have found that greater clinical experience is associated with lower morbidity. The techniques of hernia surgery range from open to laparoscopic repair and have been investigated in small prospective studies, while larger databases have been used to analyze outcomes retrospectively.
Collapse
|