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A Comparative Study of Laparoscopic versus Open Management of Index Small Bowel Obstruction in Children
Utsav M Patwardhan1, Gretchen M Floan1, Richard Y Calvo2
1Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA.
Insights
Laparoscopic surgery for pediatric adhesive small bowel obstruction (ASBO) is increasingly used and offers better outcomes than open surgery, including fewer complications and shorter hospital stays. Benefits and risks of each approach require careful consideration.
Area of Science:
- Pediatric surgery
- Gastrointestinal surgery
- Minimally invasive surgery
Background:
- Limited literature exists on optimal treatment strategies for adhesive small bowel obstruction (ASBO) in children.
- Comparing laparoscopic (LAP) and open (OPEN) surgical approaches for pediatric ASBO is crucial.
Purpose of the Study:
- To compare the rates and outcomes of laparoscopic versus open surgery for pediatric adhesive small bowel obstruction.
- To analyze trends in surgical management and associated complications over time.
Main Methods:
- Retrospective analysis of a California statewide database (2007-2020).
- Inclusion of pediatric patients (<18 years) with index ASBO, excluding non-operatively treated cases.
- Primary outcome: operative management type (LAP vs. OPEN); secondary outcomes: hospital characteristics, demographics, and postoperative complications.
Main Results:
- Laparoscopic surgery use increased over the study period, particularly in older children.
- LAP was associated with significantly fewer overall complications, lower rates of bowel resection, shorter length of stay (LOS), and decreased TPN use compared to OPEN.
- Mortality rates were equivalent between groups, and while LAP had lower readmission rates, the time to readmission was similar.
Conclusions:
- Laparoscopic surgery for pediatric ASBO has shown increasing utilization and superior outcomes regarding complications, LOS, TPN use, and readmissions.
- Laparoscopic approach was less common in younger children, indicating a need to weigh benefits and risks for each patient.
- Further research may explore factors influencing the choice between laparoscopic and open surgery in pediatric ASBO.
Introduction:
There is limited literature on the optimal approach to treat adhesive small bowel obstruction (ASBO) in children. We sought to compare rates and outcomes of laparoscopic (LAP) and open (OPEN) surgery for pediatric ASBO.
Methods:
A California statewide database was used to identify children (<18 years old) with an index ASBO from 2007 to 2020. The primary outcome was the type of operative management: LAP or OPEN. Secondary outcomes were hospital characteristics, patient demographics, and postoperative complications. We excluded patients treated non-operatively.
Results:
Our study group had 545 patients. 381 (70%) underwent OPEN and 164 (30%) LAP during the index admission. Over the study period, there was increasing use of laparoscopic surgery, with higher use in older children (p < 0.001). LAP was associated with fewer overall complications (65.2% vs. 81.6%, p < 0.001), with a decreasing trend in complications over time (p < 0.001). The LAP group had significantly lower rates of bowel resection (4.9% vs. 17.1%, p < 0.001), length of stay (LOS) (17 vs. 23 days, p < 0.001), and TPN use (12.2% vs. 29.1%, p < 0.001). Mortality rates were equivalent. Although the LAP group had lower readmission rates (22.6% vs. 37.3%, p < 0.001), the length of time between discharge and readmission was similar (171 vs. 165 days, p = 0.190).
Discussion:
The use of laparoscopic surgery for index ASBO increased over the study period. However, it was less commonly utilized in younger children. LAP had fewer overall complications as well as shorter LOS, decreased TPN use, and fewer readmissions. The benefits and risks of each approach must be weighed.
Level Of Evidence:
III.
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