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Postoperative intestinal obstruction after laparoscopic versus open surgery in the pediatric population: A 15-year
F Molinaro1, C Kaselas, I Lacreuse
1Department of Pediatric Surgery, University of Strasbourg, France. fmolidoc@virgilio.it
Insights
Laparoscopic surgery in children significantly lowers the risk of postoperative intestinal obstruction (PIO) compared to open surgery. Laparotomy also increases the chance of re-operation if PIO develops.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Postoperative intestinal obstruction (PIO) is a significant complication in pediatric abdominal surgery.
- Minimally invasive techniques like laparoscopy are increasingly adopted in pediatric surgery.
Purpose of the Study:
- To compare the incidence of PIO in infants and children undergoing laparoscopic versus open abdominal surgery.
- To evaluate the risk of re-operation following PIO in relation to the initial surgical approach.
Main Methods:
- Retrospective analysis of pediatric abdominal operations performed between 1992 and 2007.
- Comparison of PIO rates between laparoscopic and open (laparotomy) approaches for comparable surgical procedures.
- Analysis of re-operation rates for PIO based on the initial surgical method.
Main Results:
- A total of 2,243 comparable abdominal operations were analyzed.
- Laparoscopic surgery was associated with a significantly lower incidence of PIO (0.89%) compared to laparotomy (3.21%) (p<0.0001).
- Patients initially treated with laparotomy had a higher risk of re-operation for PIO than those treated with laparoscopy.
Conclusions:
- Laparoscopic abdominal surgery in children is associated with a reduced likelihood of developing postoperative intestinal obstruction.
- The risk of re-operation for PIO is substantially higher in pediatric patients initially treated with open laparotomy compared to laparoscopy.
Purpose:
The aim of the study was to determine the possible advantages of a laparoscopic approach versus open surgery in infants and children with regard to the development of postoperative intestinal obstruction (PIO).
Material And Methods:
A retrospective study was performed. The medical records of all infants and children who underwent an abdominal operation in our department between 1992 and 2007 were included. Data included initial diagnosis, age at initial operation, initial surgical approach, time to PIO, and type of definitive treatment.
Results:
From 1992 to 2007, a total of 3 600 abdominal operations were performed in our institution. As not all types of operations can be performed using a laparoscopic approach, in order to obtain a more exact result we compared only operations of the same type performed either by laparoscopy or laparotomy in this period. A total of 2 243 comparable abdominal operations were performed, of which 1 558 (69.46%) were performed using a laparoscopic approach and 685 (30.54%) were performed by laparotomy. Postoperative intestinal obstruction (PIO) was diagnosed in 36 cases. In 14 of these patients (38.88%), the initial operation was performed via a laparoscopic approach, while the remaining 22 (61.12%) were initially operated using laparotomy. Overall, 0.89% of the patients initially managed by laparoscopy and 3.21% of the patients initially treated by laparotomy were treated for postoperative intestinal obstruction (p<0.0001).
Conclusion:
Abdominal surgery via a laparoscopic approach reduces the likelihood of PIO development. The risk for re-operation after development of PIO in infants and children is significantly higher in patients initially treated by laparotomy than for patients treated by laparoscopy.
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