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The risks of minimal access surgery in children: an aid to consent
Boma T Adikibi1, Gordon A Mackinlay, M Claire C Clark
1Royal Hospital for Sick Children, EH9 1LF Edinburgh, UK. boma.adikibi@nhs.net
Aim:
The aim of this study was to determine the risk of complications and conversions for minimally invasive procedures in children, thus allowing properly informed consent.
Methods:
Data were retrieved for all minimally invasive surgical procedures performed between 1995 and 2009.
Results:
There were 2352 cases performed in 2288 (1428 were male) patients. Of these, 2210 cases (94%) were laparoscopic, and 143 (6%), thoracoscopic. The median age at operation was 6 years and 4 months. The overall complication rate was 3.6%, with the risk of early reoperation at 1.7%. The risk was highest for fundoplication and pyloromyotomy at 3.2% and 4%, respectively. The risk of an infective complication was 0.5% and was highest for appendicectomy and nephrectomy. The risk of visceral injury overall in this series was 0.4%. Visceral injury, explicable only by port insertion, occurred in just under 1 in 1000 cases. The conversion rate was 2.3%. The lowest rates were observed with appendicectomy, fundoplication, and pyloromyotomy. Thoracoscopic cases, nephrectomies, and procedures for an underlying oncological diagnosis had a higher conversion rate.
Conclusion:
Informed consent requires knowledge of the risks of surgery. This series may serve as an aid for other units in obtaining consent for minimally invasive surgery in the pediatric population.
