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Laparoscopic and thoracoscopic surgery in infancy and childhood, the Münster/Gent experience
K Schaarschmidt1, I Kerremanns, J Schleef
1Hospital for Pediatric Surgery, Münster University, FRG.
Insights
Minimally invasive laparoscopic and thoracoscopic surgery are safe and effective for pediatric patients. These endoscopic procedures in children demonstrate low complication rates and improved recovery, making them a reliable surgical option.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Endoscopic Procedures
Background:
- Laparoscopic and thoracoscopic surgery are widely used in adults but less common in pediatric care.
- Endoscopic surgery offers potential benefits including reduced pain and faster recovery.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic and thoracoscopic surgery in a pediatric population.
- To document the outcomes of various endoscopic procedures performed on children.
Main Methods:
- Prospective documentation of 168 pediatric patients undergoing endoscopic surgery over three years.
- Procedures included appendectomy, diagnostic procedures, adhesiolysis, cholecystectomy, bowel resection, and more.
Main Results:
- Overall morbidity was low at 1.8%, with only four wound infections (2.4%) reported.
- No deaths occurred, and benefits included better diagnostic visualization, reduced pain, and shorter hospital stays.
Conclusions:
- Laparoscopic and thoracoscopic surgery are safe and reliable for children.
- Endoscopic procedures yield encouraging results, with excellent aesthetic outcomes and minimal hospitalization.
Abstract:
Laparoscopic and thoracoscopic surgery have had a tremendous impact on adult surgery, but are still rarely used in children. In the past 3 years 168 children have been treated endoscopically in the three cooperating institutions. The course of all patients was documented prospectively in order to determine the value and prove the safety of endoscopic surgery in children. The operations performed endoscopically comprised appendectomy (n = 39), diagnostic procedures (24), adhesiolysis (n = 22), cholecystectomy (n = 13), bowel resection (n = 8), pyloromyotomy (n = 6), ovarial resection (n = 6), hiatus hernia repair (n = 22), splenectomy (n = 6), first stage of Fowler-Stephens operation for kryptorchidism (n = 3) and interruption of persistent botallic ducts (n = 6) in preterm infants. Apart from four wound infections (2.4%) following perforated appendicitis, one of which required laparotomy for perityphlitic abscess there were no serious complications. No patient died, and overall morbidity related to the procedure was 1.8% (i.e. incidence of uneventful minor intraoperative complications). Furthermore endoscopic surgery provides a better diagnostic survey of the abdomen or thorax so that missing of secondary pathology is unlikely. Pain and reflectory impairment of bowel-function or respiration were diminished, the aesthetic results were excellent and hospitalization could be reduced to a minimum. It is concluded that laparoscopic and thoracoscopic surgery are safe and reliable procedures for children and yield very encouraging results.