Laparoscopic versus open ileal Pouch-Anal anastomosis in paediatric patients: A systematic review and meta-analysis

Background: Restorative Proctocolectomy (RP) with Ileal Pouch-Anal Anastomosis (IPAA) represents the gold-standard surgical treatment for patients requiring total colonic and rectal removal due to ulcerative colitis, familial adenomatous polyposis, and other colonic pathologies. The laparoscopic approach (L-IPAA) has been increasingly utilized in pediatric and young adult populations to enhance recovery and reduce morbidity; however, its benefits over open surgery (O-IPAA) remain uncertain. This meta-analysis aimed to compare outcomes between L-IPAA and O-IPAA, focusing on complications, operative time, and length of hospital stay (LOS). Methods: A systematic review and meta-analysis were performed according to PRISMA guidelines, including comparative studies of patients <21 years undergoing IPAA. Databases searched included PubMed, Ovid, and Cochrane CENTRAL up to September 2025. Primary outcomes were major intra- and post-operative complications; secondary outcomes included minor complications, operative time, and LOS. Data were analyzed using random-effects models, with risk of bias assessed via ROBINS-I and evidence quality graded using the GRADE system. Results: Eight studies encompassing 1094 patients met inclusion criteria: 412 underwent O-IPAA and 682 underwent L-IPAA. No significant differences were found in major intra-operative (OR = 0.871, p = 0.888) or major post-operative complications (OR = 0.798, p = 0.599). L-IPAA showed a trend toward fewer minor complications (OR = 0.514, p = 0.071) and demonstrated a significantly shorter hospital stay (OR = 0.480, p < 0.001). Operative time was significantly longer in the laparoscopic group (OR = 1.784, p < 0.001). Heterogeneity across studies was moderate to high, and the overall certainty of evidence ranged from very low to moderate. Conclusion: Both laparoscopic and open IPAA are safe and effective for pediatric and young adult patients requiring total proctocolectomy. While laparoscopic surgery entails a longer operative time, it offers a clear benefit in reducing hospital stay, with comparable complication rates. Further multicenter randomized studies are needed to validate these findings and define the optimal surgical approach.