Use of Laparoscopy in Pediatric Blunt and Spleen Injury: An Unexpectedly Common Procedure After Cessation of Bleeding

Area of Science:

• Pediatric Surgery
• Trauma Surgery
• Minimally Invasive Surgery

Background:

• Laparoscopy is emerging in pediatric trauma care, particularly for gastrointestinal and pancreatic injuries.
• Its role in blunt liver or spleen injury (BLSI) in children is less defined.
• This study examines the selective use of laparoscopy in pediatric BLSI.

Purpose of the Study:

• To describe the frequency and application of laparoscopic procedures in children with blunt liver or spleen injury (BLSI).
• To analyze the timing and indications for laparoscopy in pediatric BLSI management.

Main Methods:

• A secondary analysis of prospective data from a multicenter trial involving 10 Level 1 pediatric trauma centers.
• Inclusion criteria: children aged ≤18 years with BLSI.
• Focus on patients who underwent laparoscopic procedures during their index admission.

Main Results:

• Of 1008 children with BLSI, 11 underwent laparoscopy during their index admission (16% of those requiring abdominal surgery).
• Median age of laparoscopic patients was 11.5 years; median time to surgery was 42 hours postinjury.
• Laparoscopy was used for diagnostic purposes, drain placement, and in cases of liver, spleen, pancreatic, or bowel injuries (some converted to open laparotomy).

Conclusions:

• Laparoscopy is selectively utilized in pediatric BLSI management, often delayed post-injury.
• The procedure serves various roles, including diagnosis and intervention for associated injuries.
• Further research is needed to optimize the timing and indications for laparoscopy in pediatric BLSI.