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Complications of laparoscopic surgery in neonates and small infants
Tadashi Iwanaka1, Hiroo Uchida, Hiroshi Kawashima
1Department of Pediatric Surgery, Saitama Children's Medical Center, Iwatsuki, Saitama, Japan.
Insights
Laparoscopic surgery is feasible in infants under 5 kg, with similar overall complication rates. However, Nissen fundoplication in this group requires extra care due to increased risks of severe complications.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic surgery in infants presents unique challenges.
- Pediatric surgeons often report difficulties with laparoscopic procedures in neonates.
Purpose of the Study:
- To assess the complication rates of laparoscopic surgery in infants weighing less than 5 kg.
- To compare these complications with those in larger infants and children.
Main Methods:
- Retrospective analysis of 154 infants (<5 kg, group S), 96 infants (<10 kg, group M), and 335 children (>10 kg, group L).
- Evaluation of intraoperative and postoperative complications.
- Specific focus on 60 Nissen fundoplication cases across groups.
Main Results:
- Overall complication rates were similar across groups S (9.7%), M (15.6%), and L (9.6%).
- Nissen fundoplication in group S showed a significantly higher complication rate (5/15) compared to group L (1/23, P=.04).
- Major complications in group S included gastrointestinal perforation and vagal nerve injury.
Conclusions:
- Laparoscopic surgery is a viable option for infants, including those weighing less than 5 kg.
- Nissen fundoplication in very small infants necessitates heightened vigilance to prevent severe intraoperative complications.
Purpose:
The difficulty of performing laparoscopic surgery in small infants remains a common complaint of pediatric surgeons. The aim of this study was to evaluate the complications of laparoscopic surgery in small infants weighing less than 5 kg.
Methods:
Since 1997, 154 infants weighing less than 5 kg underwent laparoscopic surgery (group S). During that same period, 96 infants weighing less than 10 kg (group M) and 335 children weighing more than 10 kg (group L) also underwent laparoscopic surgery. Intra- and postoperative complications were evaluated and compared between the 3 groups, especially in the 60 cases that underwent Nissen fundoplication. P < .05 was considered a significant difference.
Results:
Complications such as gastrointestinal perforation and wound infection were observed in 15 (9.7%), 15 (15.6%), and 32 (9.6%) infants of groups S, M, and L, respectively. There were no significant differences in complication rates among the 3 groups. However, in Nissen fundoplication, 5 of 15 patients in group S had complications, thereby significantly increasing the complication rate as compared with group L (1 of 23, P = .04). Major complications in group S were gastrointestinal perforation and vagal nerve injury.
Conclusions:
Laparoscopic surgery is feasible even in small infants. However, in Nissen fundoplication, special attention is necessary to avoid severe intraoperative complications.
