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Abdominal wall elasticity of children during pneumoperitoneum

Ruijie Zhou1, Hualin Cao2, Qing Gao1

  • 1Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, People's Republic of China.

Journal of Pediatric Surgery
|July 17, 2019
PubMed

Insights

Pediatric laparoscopic surgery can be improved by understanding abdominal wall elasticity. Stretching the abdomen increases working space, with elasticity varying by age and measurement axis.

Area of Science:

  • Pediatric Surgery
  • Minimally Invasive Surgery
  • Abdominal Wall Mechanics

Background:

  • Laparoscopic surgery in children is limited by restricted abdominal working space.
  • Abdominal wall stretching is used to compensate for limited space, but its effectiveness is not well understood.
  • Knowledge gaps exist regarding the volume of space gained and age-related changes in abdominal wall elasticity.

Purpose of the Study:

  • To investigate the extent of abdominal wall elasticity during pneumoperitoneum in pediatric patients.
  • To analyze how abdominal wall elasticity changes with age and intra-abdominal pressure.
  • To evaluate the impact of prestretching on abdominal wall elasticity.

Main Methods:

  • One hundred sixty-three children (<18 years) undergoing elective laparoscopic surgery were enrolled.
  • Abdominal wall dimensions were measured at varying intra-abdominal pressures (0-12 mmHg) before and after prestretching.
  • Patients were categorized into infants (<1 year) and older children (≥1 year).

Main Results:

  • Pediatric abdominal walls can stretch up to 17% with pneumoperitoneum, with stretch decreasing at higher pressures.
  • Longitudinal elasticity decreases with age, while transverse elasticity increases in older children.
  • Pre-stretching significantly enhances elasticity in the transverse and lower sagittal abdominal wall, irrespective of age.

Conclusions:

  • The pediatric abdominal wall exhibits significant expandability, with elasticity characteristics varying by measurement axis and patient age.
  • Pre-stretching is a viable method to improve intra-abdominal working space in pediatric laparoscopic surgery.
  • Findings can inform port placement strategies for pediatric minimally invasive procedures.
Abstract

Keywords:
CO(2) pneumoperitoneumElasticity of abdominal wallIntraabdominal pressurePediatric laparoscopic surgeryPrestretching

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