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Laparoscopy Compared With Laparotomy for the Management of Pediatric Blunt Abdominal Trauma
Elissa K Butler1, Brianna M Mills2, Saman Arbabi1
1Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Surgery, University of Washington, Seattle, Washington.
Insights
Laparoscopy may offer improved outcomes for hemodynamically stable pediatric patients with blunt abdominal injuries compared to laparotomy, including shorter hospital stays and fewer infections. This study evaluated surgical approaches in this patient group.
Area of Science:
- Pediatric surgery
- Trauma surgery
- Minimally invasive surgery
Background:
- Limited evidence exists on laparoscopy for hemodynamically stable children with abdominal injuries.
- Pediatric blunt abdominal trauma management requires careful consideration of surgical approaches.
Purpose of the Study:
- To evaluate postoperative outcomes in pediatric patients with blunt abdominal injury.
- To compare outcomes of laparotomy versus laparoscopy in hemodynamically stable children.
Main Methods:
- Analysis of the 2015-2016 National Trauma Data Bank.
- Inclusion of pediatric patients (<18 years) with Injury Severity Score (ISS) ≤25 and Glasgow Coma Scale (GCS) ≥13.
- Comparison of outcomes across laparotomy, laparoscopy, and converted laparoscopy groups using inverse probability weighting.
Main Results:
- Laparoscopy group showed a shorter mean hospital length of stay (2.1 days) and ICU length of stay (1.1 days) compared to laparotomy.
- The laparoscopy group had a 2.0% lower mean probability of surgical site infection.
- 720 patients were analyzed: 504 laparotomy, 132 laparoscopy, 84 converted laparoscopy.
Conclusions:
- Laparoscopy may be associated with improved outcomes in hemodynamically stable pediatric patients with blunt abdominal injury.
- Further research may confirm the benefits of minimally invasive approaches in this population.
Background:
There is minimal evidence evaluating the risks and benefits of laparoscopy use in hemodynamically stable children with suspected abdominal injuries. The objective of this study was to evaluate postoperative outcomes in a large cohort of hemodynamically stable pediatric patients with blunt abdominal injury.
Methods:
Using the 2015-2016 National Trauma Data Bank, all patients aged <18 y with injury severity score (ISS) ≤25, Glasgow coma scale ≥13, and normal blood pressure who underwent an abdominal operation for blunt abdominal trauma were included. Patients were grouped into three treatment groups: laparotomy, laparoscopy, and laparoscopy converted to laparotomy. Treatment effect estimation with inverse probability weighting was used to determine the association between treatment group and outcomes of interest.
Results:
Of 720 patients, 504 underwent laparotomy, 132 underwent laparoscopy, and 84 underwent laparoscopy converted to laparotomy. The median age was 10 (IQR: 7-15) y, and the median ISS was 9 (IQR: 5-14). Mean hospital length of stay was 2.1 d shorter (95% confidence interval [CI]: 0.9-3.2 d) and mean intensive care unit length of stay was 1.1 d shorter (95% CI: 0.6-1.5 d) for the laparoscopy group compared with the laparotomy group. The laparoscopy group had a 2.0% lower mean probability of surgical site infection than the laparotomy group (95% CI: 1.0%-3.0%).
Conclusions:
In this cohort of hemodynamically stable pediatric patients with blunt abdominal injury, laparoscopy may have improved outcomes over laparotomy.
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