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Published on: October 29, 2014
Surgical management of pediatric adhesive bowel obstruction
Justin Lee1, David B Tashjian, Kevin P Moriarty
1Baystate Pediatric Surgery, Baystate Children's Hospital, Tufts University School of Medicine, Springfield, Massachusetts, USA. Justin.Lee@tufts.edu
Insights
Laparoscopic lysis of adhesions (LOA) is a safe, effective treatment for pediatric adhesive bowel obstruction, showing fewer complications and lower costs than open surgery. Increased use of laparoscopy is noted, but it remains underutilized in pediatric cases.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Pediatric adhesive bowel obstruction is a significant surgical challenge.
- Open lysis of adhesions (LOA) has been the traditional approach.
- Recent trends in surgical management warrant analysis.
Purpose of the Study:
- To analyze recent trends in the surgical management of pediatric adhesive bowel obstruction.
- To compare outcomes of open versus laparoscopic lysis of adhesions (LOA).
Main Methods:
- Analysis of the Kids' Inpatients Database (1997-2009).
- Inclusion of pediatric adhesive bowel obstruction cases.
- Comparison of demographics, hospital variables, length of stay, hospital charges, and complication rates between open and laparoscopic LOA.
Main Results:
- A significant increase in laparoscopic LOA utilization from 7.2% to 17.2% was observed.
- Laparoscopic LOA demonstrated lower complication rates (5.6% vs 10.4%) and accidental puncture/laceration rates (2.2% vs 3.9%).
- Laparoscopy was associated with shorter length of stay and lower total hospital charges.
Conclusions:
- Laparoscopic LOA is a safe and cost-effective option for pediatric adhesive bowel obstruction.
- Despite increased utilization, laparoscopy is still underused in this patient population.
- Further research is needed to identify optimal candidates for laparoscopic LOA.
Introduction:
The objective of this study was to analyze a population-based database for recent trends in surgical management of pediatric adhesive bowel obstruction and compare open versus laparoscopic lysis of adhesions (LOA).
Subjects And Methods:
Pediatric adhesive bowel obstruction cases were identified in the Kids' Inpatients Database from 1997, 2000, 2003, 2006, and 2009. Data analysis included patients' demographics, hospital variables, length of stay (LOS), and total hospital charges (THC). Complications analysis included postoperative shock, hemorrhage, hematoma, seroma, wound complications, infection, fistula, and pulmonary complications.
Results:
In total, 20,679 pediatric adhesive bowel obstruction cases were identified during the study period. These were characterized by a median age of 11 years old, with 59.0% of the population female. Overall treatment included 88.6% open and 11.4% laparoscopic LOA. A more than twofold increase in utilization of laparoscopy was observed from 7.2% in 1997 to 17.2% in 2009 (P<.001). Complication rates were lower for laparoscopic LOA versus open (5.6% versus 10.4%; odds ratio 0.512; 95% confidence interval 0.394-0.667; P<.001), especially accidental puncture or laceration rate (2.2% versus 3.9%; odds ratio 0.566; 95% confidence interval 0.375-0.854; P=.006). Conversion to open LOA occurred in 1.9%. Laparoscopy was associated with a shorter median LOS (6 versus 8 days; P<.001) and a lower mean THC ($38,241.11 versus $48,552.51; P<.001) compared with open LOA. Multivariate regression analysis did not find hospital bed size, location, teaching status, and regions to be statistically significant predictors for utilization of laparoscopy.
Conclusions:
Laparoscopic LOA is a safe option for pediatric adhesive bowel obstruction with lower complication rates and a reduced economic burden. Despite the increase in utilization of laparoscopy in recent years, only a minority of patients underwent laparoscopic LOA. Further studies are needed to identify and characterize the subgroup of patients who benefit from laparoscopic LOA.
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