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Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children
Utsav M Patwardhan1, Casey R Erwin2, Alexandra S Rooney3
1Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA; Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
Insights
Laparoscopy (LAP) in children with penetrating abdominal trauma is uncommon, mainly used for stab wounds at pediatric centers. LAP patients experienced fewer subsequent procedures, indicating its safety and efficacy in select pediatric cases.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Minimally Invasive Surgery
Background:
- Literature on laparoscopy (LAP) for stable pediatric penetrating abdominal trauma is limited.
- Evidence suggests LAP benefits selective adult trauma patients.
- This study reviews contemporary practices and outcomes of LAP in pediatric trauma.
Purpose of the Study:
- To evaluate the utilization and outcomes of laparoscopy in children with penetrating abdominal trauma.
- To compare laparoscopy with open surgery in this patient population.
- To identify factors influencing LAP use and its impact on patient outcomes.
Main Methods:
- Utilized the American College of Surgeons (ACS) Trauma Quality Programs data (2016-2021).
- Included children (<18 years) with penetrating abdominal injury undergoing surgery within 24 hours.
- Excluded patients with severe non-abdominal injuries, low Glasgow Coma Scale (GCS), or instability (SIPA cutoff).
- Compared outcomes (length of stay, complications) for LAP, open, and laparoscopic converted to open (LCO) groups.
Main Results:
- 1945 patients analyzed; 32% stab wounds, 68% gunshot wounds (GSW).
- LAP used in 12% and LCO in 7.4%; LAP use did not change over time.
- LAP more common for stab wounds (24%) than GSW (7%) and at pediatric centers.
- No difference in mortality or complications by operative type.
- Open surgery patients had longer length of stay and more subsequent procedures.
Conclusions:
- Laparoscopy is underutilized in stable pediatric penetrating abdominal trauma, primarily used for stab wounds at specialized centers.
- LAP is associated with fewer subsequent procedures, suggesting low rates of missed injuries.
- Further criteria development is needed to identify pediatric patients who could benefit from a laparoscopic approach.
Introduction:
In stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients.
Methods:
The American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (<18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission. Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) < 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries.
Results:
Among 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < .01). There was higher use of LAP at pediatric centers (p < .01). Although there was no difference in mortality or complications by operative type, open patients were more severely injured, had a longer LOS (p < .01), and had more subsequent procedures (11% of open, 2 % LAP, 7% LCO, p < .01).
Conclusion:
In stable children with penetrating abdominal trauma, LAP is most often utilized after stabbing and at pediatric trauma centers, but its overall use remains uncommon. LAP patients had lower rates of subsequent procedures and no increase in unexpected operations suggesting low rates of missed injuries. Criteria are needed to identify stable patients presenting after penetrating trauma who can benefit from a LAP approach.
Level Of Evidence:
III.
