Diagnostic and therapeutic laparoscopy in pediatric abdominal trauma
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Alexander Feliz1, Barbara Shultz, Chris McKenna
1Benedum Program in Trauma, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
Insights
Laparoscopy in pediatric trauma is a safe and effective diagnostic tool for abdominal injuries. It reduces nontherapeutic laparotomies and associated morbidity in children.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Minimally Invasive Surgery
Background:
- Pediatric abdominal trauma requires accurate diagnosis and effective treatment.
- Traditional laparotomy carries risks of morbidity, especially when nontherapeutic.
- Emergent laparoscopy offers a potential alternative for evaluation and management.
Purpose of the Study:
- To evaluate the role of emergent laparoscopy in diagnosing and treating pediatric abdominal trauma.
- To assess laparoscopy's impact on diagnostic accuracy and nontherapeutic laparotomy rates.
- To determine if laparoscopy reduces morbidity in pediatric trauma patients.
Main Methods:
- Retrospective review of a pediatric level I trauma center database (2000-2004).
- Analysis of 113 patients undergoing abdominal exploration for blunt or penetrating trauma.
- Comparison of outcomes between patients who underwent laparoscopy versus laparotomy.
Main Results:
- Laparoscopy was performed in 32 (28%) of 113 patients, avoiding laparotomy in 56%.
- Laparoscopy facilitated diagnosis and repair of injuries including perforated viscera and diaphragmatic rupture.
- Laparoscopic procedures were associated with significantly fewer ICU and hospital days and no deaths.
Conclusions:
- Emergent laparoscopy is a safe and effective modality for evaluating and treating selected pediatric abdominal injuries.
- Laparoscopy enhances diagnostic accuracy and reduces the morbidity associated with nontherapeutic laparotomies.
- This minimally invasive approach improves outcomes in pediatric trauma patients with abdominal injuries.
Purpose:
The purpose of this study is to assess the role of emergent laparoscopy as a diagnostic and potentially therapeutic modality in pediatric trauma. We hypothesize that diagnostic laparoscopy provides important information for the treatment of children with abdominal trauma and is accompanied by improved diagnostic accuracy, reduction of nontherapeutic laparotomy rates, and a reduction of morbidity.
Methods:
A 5-year (January 2000-December 2004) retrospective review of a pediatric level I trauma center database was performed after institutional review board approval was obtained, and information regarding patients who had operations for abdominal trauma was abstracted. Demographic variables, mechanism of injury, operative interventions, and patient outcomes were examined. Statistical analysis was performed using descriptive statistics and Student's t test (P < .05).
Results:
There were 7127 trauma admissions, of which 113 had abdominal explorations for blunt (88%) and penetrating (12%) trauma. Thirty-two (28%) patients had laparoscopy performed. Laparotomy was avoided in 56% of these patients. Laparoscopic therapeutic interventions were performed in 6 (19%) patients. Laparoscopy assisted in the diagnosis and subsequent conventional repair of perforated viscera in 10, diaphragmatic rupture in 3, and distal pancreatic injury in 1. Patients who had a laparoscopic procedure of any kind were less severely injured leading to significantly lower number of intensive care unit (0.6 +/- 1.6, P = .0004) and hospital days (7.4 +/- 5.6, P = .002) than patients who had a laparotomy (3.7 +/- 7.1 and 12.5 +/- 11.4). No injuries were missed, or technical complications occurred, as a result of laparoscopic explorations. There were 6 deaths in the laparotomy group. No patients who underwent laparoscopy died.
Conclusion:
Laparoscopy in pediatric trauma is a safe method for the evaluation and treatment of selective blunt and penetrating abdominal injuries in hemodynamically stable patients. Laparoscopy serves as a diagnostic tool in abdominal trauma, which reduces the morbidity of a negative laparotomy.
