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Year : 2021  |  Volume : 26  |  Issue : 1  |  Page : 6-10

Top 100 Most Influential Manuscripts in Congenital Abdominal Pediatric Surgery: A Bibliometric Analysis

1 Faculty of Medicine, St. George's University of London, London, UK
2 Faculty of Medicine, University College London, London, UK
3 Faculty of Medicine, Imperial College London, London, UK
4 Department of Cardiothoracic Surgery, University Hospitals, Coventry and Warwickshire, Coventry, UK

Date of Submission13-Aug-2019
Date of Decision28-Sep-2019
Date of Acceptance26-Apr-2020
Date of Web Publication11-Jan-2021

Correspondence Address:
Mr. Ka Siu Fan
Faculty of Medicine, St. George's University of London, Cranmer Terrace, Tooting, London
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaps.JIAPS_129_19

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Bibliometric analysis identifies the most influential manuscripts that shape our understanding of various congenital gastrointestinal pathologies. This study sets out to analyse the 100 most cited manuscripts on congenital gastrointestinal surgery. The Thomson Reuters Web of Science database was searched for all manuscripts relevant to paediatric congenital gastrointestinal surgery. The number of citations, authorship, publication date, journal of publication, institution and country were recorded for each paper. Eigenfactor and impact factor rankings were obtained for each journal of publication. 971 eligible manuscripts were returned by the search. Within the top 100 manuscripts, the most cited paper (by Metkus et al.) investigated fetal diaphragmatic hernia and was cited 413 times. University of Indianapolis had the most publications (n=5) and Journal of Pediatric Surgery had the most citations (n=3231). The country with the most publications in top 100 were the USA (n=39). The most commonly published topics were diaphragmatic hernia (n=23), abdominal wall defect (n=20) and atresia (n=6). The most cited manuscripts include various topics with a primary focus on the aetiology, diagnosis, management and outcome of diaphragmatic hernia and abdominal wall defects. Additionally, by collecting the most influential works, this study serves to reference what makes a manuscript 'citable'.

Keywords: Abdominal, bibliometric analysis, citations, congenital, pediatric surgery

How to cite this article:
Fan KS, Chi Leung KH, Fan KH, Chan J. Top 100 Most Influential Manuscripts in Congenital Abdominal Pediatric Surgery: A Bibliometric Analysis. J Indian Assoc Pediatr Surg 2021;26:6-10

How to cite this URL:
Fan KS, Chi Leung KH, Fan KH, Chan J. Top 100 Most Influential Manuscripts in Congenital Abdominal Pediatric Surgery: A Bibliometric Analysis. J Indian Assoc Pediatr Surg [serial online] 2021 [cited 2023 Mar 30];26:6-10. Available from: https://www.jiaps.com/text.asp?2021/26/1/6/306693

   Introduction Top

Congenital disorders have contributed to early deaths and disabilities throughout history and are currently still responsible for approximately 600,000 deaths and 62 million disability-adjusted life years around the globe annually.[1],[2] The advances made in the last several decades have greatly improved outcomes for many previously life-limiting defects, while surgical success rates continue to improve.[3] Congenital defects of the alimentary tract, abdominal wall, and urinary system together affect up to 1000/100,000 of all births and are often managed through abdominal surgeries.[4] These defects reportedly cause up to 1.1% of all neonatal deaths.[5] These disorders are typically caused by defective embryogenesis of the alimentary tract, or its surrounding structures, and encompass pathologies such as malrotation, atresia, stenosis, and congenital absence of the intestines. Hence, it is not unexpected that pediatric abdominal surgery accounts for 31% of all pediatric operations.[6] With the rising prevalence of abdominal malformations, advances in knowledge are crucial to delivering better treatment outcomes and improving morbidity and mortality.[5],[7]

Many pioneering surgeons have introduced new operative techniques and concepts that revolutionized the field. With the vast volume of published material in this field, a method of identifying works that have a significant contribution to the field is bibliometric citation analysis. This involves examining the citation history of an individual publication and providing a quantitative assessment of the relative importance of a research paper. In addition to ranking articles, citation analysis serves to rank journals based on the total number of citations normalized to the number of articles published within the journal over a defined time period (impact factor). Many surgical specialties have employed citation rank analysis to identify the most important published papers, including general surgery, plastic surgery, trauma and orthopedic surgery, and cardiothoracic surgery.[8],[9],[10],[11],[12]

To date, no study has been undertaken to determine the most important works on congenital abdominal pediatric surgery. Through extensive search of the available literature, this study aims to provide insight into how our knowledge of abdominal surgery on congenital diseases has developed and how our management has changed over time. In addition, it would serve as a reference for the most cited papers on congenital intestinal diseases.

   Methods Top

Thomson Reuters Web of Science citation indexing database and research platform was used to conduct the search. All fields were searched and must include all of the following terms: “Congenital,” “Surg,” “Pediatric/Paediatric,” and “Abdominal/Abdomen/Gastro.” Using the method initially developed by Paladugu et al.,[8] and performed again by Wrafter et al.[13] and Powell et al.,[14] the dataset is filtered to only include English language manuscripts published between January 01, 1970, and June 06, 2019, and indexed under the Science Citation Index Expanded, Conference Proceedings Citation Index, or Emerging Sources Citation Index. Manuscripts are screened to exclude those that examine nonabdominal surgical topics or adult populations alone. At Web of Science, the listed citation count across all databases was recorded and includes the following: Web of Science Core Collection, BIOSIS Citation Index, Chinese Science Citation Database, Russian Science Citation Database, and SciELO Citation Index. Articles were then obtained, reviewed, and analyzed using Excel® according to authorship, journal of publication, publication date, topic, institution, and country of origin. In addition, the latest Eigenfactor and impact factor of each journal were recorded.

   Results Top

The Web of Science search returned 971 full-length English language papers, of which 17 were excluded to produce the final list of 100 most cited articles. The list of manuscripts is ordered from most to least cited.[15] This included 87 original articles and proceedings papers and 13 review articles, with a grand total of 5449 citations.

The number of citations for these manuscripts ranged from 29, for “Antenatal diagnosis of choledochal cyst” by Bancroft et al.,[16] to 413, for “Sonographic predictors of survival in fetal diaphragmatic hernia” by Metkus et al.[17] The publication date of the top 100 manuscripts spans from 1971 to 2016, with the oldest manuscript being “Duplications of the alimentary tract in infants and children” by Iyer and Mahour[18] and most recent being “Gastroschisis: A national cohort study to describe contemporary surgical strategies and outcomes” by Owen et al.[19]

The top 100 cited manuscripts were published across 22 journals, with the number of manuscripts per journal ranging from 1 to 56 [Table 1]; 15 of the journals had a single publication, while the Journal of Pediatric Surgery had 56. The Journal of Pediatric Surgery has a total of 3223 citations, while Pediatric Surgery International, with 11 manuscripts, has a total of 550 citations. Intensive Care Medicine has the highest 2017 impact factor (15.008), 5-year impact factor (10.837), and Eigenfactor (4.416) of all the journals, with 1 manuscript and 61 citations.
Table 1: Journals with top 100 cited manuscripts on congenital pediatric abdominal surgeries

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Twenty-five different countries have contributed toward the top 100 cited manuscripts, ranging between 1 and 41 publications [Figure 1]. The United States of America has the most (n = 41; 2682 citations), followed by the United Kingdom (n = 8; 575 citations), Canada (n = 6; 271 citations), and Italy (n = 6; 267 citations). The top 100 manuscripts were published from 77 different institutions with the top 3 all based in the USA: University of Indianapolis (n = 5; 258 citations), Johns Hopkins University (n = 4; 193 citations), and University of California San Francisco (n = 3; 508 citations).
Figure 1: Number of publications by country: An amount of manuscripts are shown in percentages and a total number of citations are shown in parentheses

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All first authors had one manuscript in the top 100, with the exception of Professor Piergiorgio Gamba for his work on abdominal wall defects (“Experimental Abdominal Wall Defect Repaired with Acellular Matrix” and “Abdominal Wall Defects: Prenatal Diagnosis, Newborn Management, and Long-Term Outcomes”).[20],[21] There were two senior authors with multiple manuscripts in the top 100: Professor Nick S. Adzick (n = 3; 627 citations) and Dr. Justin D. Klein (n = 2; 90 citations).[17],[22],[23]

Within the top 100 manuscripts, various pathologies were studied, including gastrointestinal atresia, cystic lymphangioma, and choledochal cysts. The highest number of manuscripts and citations on congenital diaphragmatic hernia (CDH) (n = 23; 1559 citations), followed by gastroschisis (n = 18; 786 citations) and omphalocele (n = 16; 469 citations), is shown in [Table 2]. Majority of the manuscripts are either original articles or proceedings paper (n = 88), with a minority being literature reviews (n = 13). Of the original articles, there was one randomized control trial, and the level of evidence of the reviews ranges from III to V. This includes two systematic reviews investigating chylothorax, gastroschisis, and omphalocele.
Table 2: Most frequently studied topics

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   Discussion Top

CDH was the most commonly studied condition, followed by gastroschisis and omphalocele. These are closely followed by manuscripts on gastrointestinal atresia, which includes esophageal, duodenal, jejunoileal, and colonic atresia. CDH was addressed by 23 studies out of the top 100 manuscripts and was also the topic of the most highly cited manuscript.[17] CDH results from the failure of diaphragm to fuse, allowing herniation of abdominal contents into the thoracic cavity where it impairs cardiopulmonary function and significantly increases infant mortality.[24] The overwhelming attention CDH received is not surprising as the overall survival rate of infants can range between 50% and 90% even with treatment. Hence, despite the thoracopulmonary nature of CDH, a decision was made to include CDH in our findings due to its clinical significance, involvement of alimentary tract as well as the role abdomen-based surgical approach in its management. Other common topics include lymphangioma, tracheoesophageal fistula, neoplasm and choledochal cysts, and anorectal malformation. Contrasting with CDH, a lower clinical priority of Meckel's diverticulum is reflected by the relatively few cited clinical manuscripts despite being the most common congenital malformation of the gastrointestinal tract.[25] On the other hand, while the abnormalities addressed by the top 3 cited papers are rare, present in 0.04%, 0.05%, and 0.03% of the population, respectively, they often lead to significant respiratory dysfunction and comorbidities.[26],[27],[28]

The most cited paper in pediatric gastrointestinal tract was the 1996 paper in the Journal of Pediatric Surgery by Metkus et al.,[17] “Sonographic predictors of survival in fetal diaphragmatic hernia,” which used ultrasound to prenatally diagnose CDH and characterize and correlate several anatomical features with outcome and survival of infants. These results aid parent counseling and termination decisions and provide opportunities to conduct in utero surgical intervention shown to improve postpartum pulmonary function. The second most cited paper was a single-author review by Spitz[26] in 2007, presenting detailed etiology, pathophysiology, diagnosis, treatment, outcomes, and complications of esophageal atresia. This manuscript is a Level V evidence review and marks the first comprehensive summary of the available literature on the condition and serves to provide an evidence-based aid to clinical decisions. The third most cited study was by Quinn et al.,[22] “Prenatal magnetic resonance imaging enhances fetal diagnosis,” demonstrated the utility of magnetic resonance imaging (MRI) in diagnosing various anatomical anomalies, such as CDH, while decreasing motion artifacts by moving fetuses. Their use of MRI also allowed improved accuracy, over ultrasound, in determining important factors that affect the outcome of CDH such as residual lung area and liver herniation and thus providing a powerful alternative to standard ultrasound.

Similar to other bibliometric analyses, a potential limitation to this study lies in the differences between publication dates of manuscripts: The scientific community receives longer exposure toward older publications which may amass a larger number of citations irrespective of its scientific significance.[13],[14] However, this effect may also suggest that the recent manuscripts within the top 100 added significance given their relatively limited exposure to the scientific community. Several biases such as self-citation, institutional bias, language bias, and powerful person bias have not been accounted for and may have affected the distribution of manuscripts within the top 100. As suggested by several studies, manuscripts originating from the USA continue to receive a high number of citations across various specialties and may be reflective of preferential citation of “local research” which can contribute to bias.[14],[29],[30] Furthermore, Web of Science citation numbers might not be wholly reflective of the true citation count as many available manuscripts are not included, such as those published before 1970. Finally, only first and senior authors were included, and papers that were coauthored may appear under-represented by the study design.

   Conclusion Top

The most influential manuscripts highlighted by this study relate to the etiology, diagnosis, and management, advancing our understanding and outcome of congenital diseases. Common congenital anomalies such as Meckel's diverticulum were underrepresented within the top 100 cited manuscripts, while focus was placed on rarer but clinically more significant diseases such as diaphragmatic hernia and abdominal wall defects. In addition to being a reference of what could be considered as influential, this study also provides reference for researchers as to what makes a “citable” paper within the field of congenital abdominal pediatric surgery. With ongoing research continuing in this field, the list of top 100 most cited manuscripts has the potential to change within the coming decade.

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Conflicts of interest

There are no conflicts of interest.

   References Top

World Health Organisation. Global Health Estimates: DALYs by Cause, Age and Sex. Available from: https://www.who.int/healthinfo/global_burden_disease/GHE2016_DALY_WH OReg_2000_2016_.xls. [Last accessed on 2019 Aug 01].  Back to cited text no. 1
World Health Organisation. Global Health Estimates 2016: Deaths by Cause, Age and Sex. Available from: https://www.who.int/healthinfo/global_burden_disease/GHE2016_Deaths_WBInc_2000_2016.xls?ua=1. [Last accessed on 2019 Aug 01].  Back to cited text no. 2
Farmer D, Sitkin N, Lofberg K, Donkor P, Ozgediz D. Surgical interventions for congenital anomalies. In: Essential Surgery: Disease Control Priorities. 3rd ed. Washington DC: The International Bank for Reconstruction and Development, The World Bank; 2015.  Back to cited text no. 3
British Isles. Network of Congenital Anomaly Registers. Congenital Anomaly Statistics. London: British Isles; 2012. p. 1-71. Available from: http://www.binocar.org/content/Annual report2012_FINAL_nologo.pdf. [Last accessed on 2019 Aug 01].  Back to cited text no. 4
Singh K, Kumar A. Major congenital malformations of the gastrointestinal tract among the newborns in one of the English Caribbean Countries, 1993-2012. J Clin Neonatol 2014;3:205-10. Available from: http://www.jcnonweb.com/te xt.asp?2014/3/4/205/144751. [Last accessed on 2019 Aug 01].  Back to cited text no. 5
Tzong KY, Han S, Roh A, Ing C. Epidemiology of pediatric surgical admissions in US children. J Neurosurg Anesthesiol 2012;24:391-5.  Back to cited text no. 6
Rankin J, Pattenden S, Abramsky L, Boyd P, Jordan H, Stone D, et al. Prevalence of congenital anomalies in five British regions, 1991-99. Arch Dis Child Fetal Neonatal Ed 2005;90:F374-9.  Back to cited text no. 7
Paladugu R, Schein M, Gardezi S, Wise L. One hundred citation classics in general surgical journals. World J Surg 2002;26:1099-105.  Back to cited text no. 8
Loonen MP, Hage JJ, Kon M. Plastic surgery classics: Characteristics of 50 top-cited articles in four plastic surgery journals since 1946. Plast Reconstr Surg 2008;121:320e-7e.  Back to cited text no. 9
O'Sullivan KE, Kelly JC, Hurley JP. The 100 most cited publications in cardiac surgery: A bibliometric analysis. Irish J Med Sci 2015;184:91-9.  Back to cited text no. 10
Kavanagh RG, Kelly JC, Kelly PM, Moore DP. The 100 classic papers of pediatric orthopaedic surgery a bibliometric analysis. J Bone Joint Surg Am 2013;95:e134.  Back to cited text no. 11
Chan J, Mak TL, Chu TS, Hui TL, Kwan LY. The 100 most cited manuscripts in coronary artery bypass grafting. J Card Surg 2019;34:782-7.  Back to cited text no. 12
Wrafter PF, Connelly TM, Khan J, Devane L, Kelly J, Joyce WP. The 100 most influential manuscripts in colorectal cancer: A bibliometric analysis. Surgeon 2016;14:327-36.  Back to cited text no. 13
Powell AG, Hughes DL, Wheat JR, Lewis WG. The 100 most influential manuscripts in gastric cancer: A bibliometric analysis. Int J Surg 2016;28:83-90.  Back to cited text no. 14
Fan K. Top 100 most influential manuscripts in congenital gastrointestinal surgery: A bibliometric analysis. Available from: https://www.ncbi.nlm.nih.gov/myncbi/browse/collection/58919257/. [Last accessed on 2019 Aug 01].  Back to cited text no. 15
Bancroft JD, Bucuvalas JC, Ryckman FC, Dudgeon DL, Saunders RC, Schwarz KB. Antenatal diagnosis of choledochal cyst. J Pediatr Gastroenterol Nutr 1994;18:142-5.  Back to cited text no. 16
Metkus AP, Filly RA, Stringer MD, Harrison MR, Adzick NS. Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg 1996;31:148-51; discussion 151-2.  Back to cited text no. 17
Iyer CP, Mahour GH. Duplications of the alimentary tract in infants and children. J Pediatr Surg 1995;30:1267-70.  Back to cited text no. 18
Owen A, Marven S, Johnson P, Kurinczuk J, Spark P, Draper ES, et al. Gastroschisis: A national cohort study to describe contemporary surgical strategies and outcomes. J Pediatr Surg 2010;45:1808-16.  Back to cited text no. 19
Gamba P, Conconi MT, Lo Piccolo R, Zara G, Spinazzi R, Parnigotto PP. Experimental abdominal wall defect repaired with acellular matrix. Pediatr Surg Int 2002;18:327-31.  Back to cited text no. 20
Gamba P, Midrio P. Abdominal wall defects: Prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg 2014;23:283-90.  Back to cited text no. 21
Quinn TM, Hubbard AM, Adzick NS. Prenatal magnetic resonance imaging enhances fetal diagnosis. J Pediatr Surg 1998;33:553-8.  Back to cited text no. 22
Mackenzie TC, Crombleholme TM, Johnson MP, Schnaufer L, Flake AW, Hedrick HL, et al. The natural history of prenatally diagnosed conjoined twins. J Pediatr Surg 2002;37:303-9.  Back to cited text no. 23
Chandrasekharan PK, Rawat M, Madappa R, Rothstein DH, Lakshminrusimha S. Congenital diaphragmatic hernia a review. Matern Heal Neonatol Perinatol 2017;3:6.  Back to cited text no. 24
Sagar J, Kumar V, Shah DK. Meckel's diverticulum: A systematic review. J R Soc Med 2006;99:501-5.  Back to cited text no. 25
Spitz L. Oesophageal atresia. Orphanet J Rare Dis 2007;2:24.  Back to cited text no. 26
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Ellul T, Bullock N, Abdelrahman T, Powell AG, Witherspoon J, Lewis WG. The 100 most cited manuscripts in emergency abdominal surgery: A bibliometric analysis. Int J Surg 2017;37:29-35.  Back to cited text no. 29
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  [Figure 1]

  [Table 1], [Table 2]

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