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Laparoscopy for small bowel obstruction in children--an update
Hanna Alemayehu1, Bryan David, Amita A Desai
1The Children's Mercy Hospital , Kansas City, Missouri.
Insights
Minimally invasive surgery (MIS) for pediatric small bowel obstruction (SBO) significantly reduces recovery time. Laparoscopy is a safe and effective treatment for SBO in children, with comparable postoperative morbidity across different approaches.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Small bowel obstruction (SBO) is a common surgical emergency in children.
- Minimally invasive surgery (MIS) has become increasingly prevalent in pediatric surgery.
- The role of MIS in pediatric SBO management requires ongoing evaluation.
Purpose of the Study:
- To evaluate the current role and outcomes of MIS for pediatric SBO.
- To compare MIS techniques with historical open surgery data.
- To assess the safety and efficacy of laparoscopy in managing pediatric SBO.
Main Methods:
- Retrospective review of 71 pediatric patients undergoing MIS for acute SBO (2008-2013).
- Comparison with a historical control group (2001-2008).
- Analysis of outcomes including nasogastric tube duration, time to diet, and postoperative morbidity.
Main Results:
- Adhesions were the most common cause of SBO (n=40).
- Laparoscopy and laparoscopic-assisted procedures showed significantly shorter nasogastric tube decompression and time to regular diet compared to open conversion.
- No significant difference in postoperative morbidity was observed between laparoscopy, laparoscopic-assisted, and open procedures.
Conclusions:
- Laparoscopy is a safe and effective diagnostic and therapeutic tool for pediatric SBO.
- MIS offers advantages in terms of faster recovery for pediatric SBO patients.
- Continued use of laparoscopy is recommended for managing pediatric SBO.
Introduction:
We evaluated the current role of minimally invasive surgery (MIS) in children with small bowel obstruction (SBO) at our institution.
Subjects And Methods:
A retrospective review of patients undergoing MIS for acute SBO was performed from 2008 to 2013. The study population was compared with a historical control including patients from 2001 to 2008.
Results:
There were 71 patients who met inclusion criteria; 35 were male, and 36 were female. Sixty-two children underwent laparoscopy for their first episode of SBO, and 12 underwent laparoscopy for recurrent SBO, accounting for 74 episodes of SBO managed with MIS. The most common etiology of SBO was adhesions (n=40). Laparoscopy and laparoscopic-assisted procedures were associated with shorter nasogastric tube decompression (1.4±2 days [P<.001] and 1.5±2.7 days [P=.002], respectively) and time to regular diet (3.9±4 days [P=.002] and 4.6±2.8 days [P=.024], respectively) compared with those converted to laparotomy (5.1±4.9 days of nasogastric tube decompressions and 8±4.7 days to regular diet). There was no difference in postoperative morbidity comparing laparoscopy (11%), laparoscopic-assisted (5%), and laparoscopic converted to open procedures (18%) (P=.48).
Conclusions:
Laparoscopy continues to be a safe diagnostic and therapeutic tool in the management of pediatric SBO.
