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Laparoscopic full-thickness intestinal biopsies in children
1Department of Surgery, Division of Pediatric Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
Insights
Laparoscopic full-thickness intestinal biopsy is a safe and effective minimally invasive procedure for diagnosing pediatric gastrointestinal conditions. This technique offers a short hospital stay and minimal pain, even in children with prior abdominal surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Procedures
Background:
- Laparoscopy may reduce postoperative pain and hospital stay compared to laparotomy.
- Laparoscopic full-thickness intestinal biopsy in children had not been previously reported.
Observation:
- Eleven children (1.6-19 years) underwent laparoscopic full-thickness biopsy of the stomach, small bowel, or colon.
- Procedures utilized one 12-mm and two 5-mm ports.
- Nine patients had prior laparotomy, with ports placed through existing scars.
Findings:
- Diagnoses included intestinal neuronal dysplasia, enzyme-induced fibrosing colonopathy, nonspecific inflammation, and plasmacytoma.
- Median hospital stay was 2 days, with <24 hours of narcotics needed per patient.
- No leaks, morbidity, or mortality occurred; no conversions to open surgery were required.
Implications:
- Laparoscopic full-thickness intestinal biopsy is safe and effective for pediatric gastrointestinal issues.
- The technique is associated with short hospital stays, minimal pain, and low complication risk.
- It is a viable option for children, including those with previous laparotomies.
Background:
Laparoscopy may reduce postoperative pain and hospital stay, compared with laparotomy. The use of laparoscopic surgery to obtain full-thickness intestinal biopsies in children has not been previously reported.
Methods:
Eleven children aged 1.6 to 19 years (median, 4.5 years) underwent laparoscopic full-thickness biopsy of the stomach, small bowel, colon, or a combination thereof. Each procedure used one 12-mm and two 5-mm ports.
Results:
Eight children with obstructive symptoms after a pull-through for Hirschsprung disease underwent multiple colon and small bowel biopsies (range, 3-6; median, 5); intestinal neuronal dysplasia was found in two. Two patients with cystic fibrosis had diffuse colonic narrowing; a diagnosis of enzyme-induced fibrosing colonopathy was made in one and nonspecific inflammation was found in the other. One child had a thickened stomach, and a gastroscopic-directed full-thickness biopsy revealed plasmacytoma. Nine of the 11 patients had a previous laparotomy, and ports were placed through preexisting scars. Median hospital stay was 2 days. No patient required more than 24 hours of narcotics. There were no leaks, and no other morbidity or mortality occurred. None of the patients required conversion to an open procedure. Biopsy results significantly affected treatment for each patient.
Conclusions:
Laparoscopic full-thickness intestinal biopsy is safe and effective for a variety of gastrointestinal problems in children. This technique is associated with a short hospital stay, minimal pain, and a very low risk of complications and can be performed even in patients who have had a previous laparotomy.
