Diagnostic and therapeutic laparoscopy in pediatric blunt abdominal trauma: a systematic review

Laparoscopy is increasingly recognized as a valuable tool in pediatric trauma management, offering the benefits of reduced morbidity compared to traditional open laparotomy. However, its precise role in blunt abdominal trauma in children remains controversial due to concerns about diagnostic accuracy, technical complexity, and patient safety. This systematic review aimed to synthesize current evidence regarding the indications, clinical outcomes, and safety profile of laparoscopic management in pediatric blunt abdominal trauma. A systematic literature search was conducted in PubMed, Web of Science, Lilacs, Scielo, and Scopus databases for studies published between January 2010 and December 2025. Eligible studies included pediatric patients (≤ 18 years old) with blunt abdominal trauma who underwent diagnostic or therapeutic laparoscopy. Screening and data extraction were performed independently by two reviewers using the Rayyan web application, following PRISMA guidelines. A descriptive analysis summarized patient characteristics, injury patterns, operative details, conversions, complications, and mortality. Twenty studies comprising 255 pediatric patients were included, with a median age of 9 years. The available evidence was predominantly derived from case reports and small case series. Conversion from laparoscopy to open surgery occurred in 39.2% of cases, reflecting both the diagnostic role of laparoscopy and intraoperative findings requiring definitive management. The most commonly reported injuries involved the bowel, pancreas, spleen, and liver. Laparoscopy was frequently used as a diagnostic tool and, in selected cases, enabled therapeutic intervention, with generally low reported complication rates and no mortality in the included studies. Median length of hospital stay was 5 days. Laparoscopy appears to be a feasible and potentially valuable adjunct in the management of pediatric blunt abdominal trauma in carefully selected, hemodynamically stable patients. It may contribute to reducing non-therapeutic laparotomies and provide both diagnostic and therapeutic benefits. However, given that current evidence is largely limited to low-level studies, these findings should be interpreted with caution and considered hypothesis-generating. Further prospective and comparative studies are required to better define its role and optimize patient selection.