Laparoscopy in infants and children: A prospective study on feasibility and the impact on routine surgery

Background/Purpose: The feasibility of laparoscopy in children and its impa ct on routine pediatric surgery are not well established. The purpose of th is study was to determine the role of laparoscopy in a university departmen t of pediatric surgery. Methods: All children undergoing laparoscopy during the period of 1 year we re included in a prospective trial. Data on patients, the operation, techni cal problems, intraoperative events, and the postoperative course were docu mented using standardized questionnaires. All patients underwent at least 1 follow-up assessment 2 weeks after the operation. All conventional abdomin al operations performed during the same period were analyzed for comparison purposes. Results: Of 244 abdominal operations performed during the study period, 147 (60.2%) were laparoscopies. One hundred twenty-three (83.7%) of these incl uded a laparoscopic operation, and 24 (16.3%) were diagnostic procedures. O f 26 types of laparoscopic operations 3 were performed more than 15 times ( fundoplication, appendectomy, pyloromyotomy), and 9 types were performed on ce. Problems with instruments and devices led to a mean time loss of 15.1 m inutes in 15.6% of the procedures. The conversion rate was 10.1% mainly bec ause of complicated appendicitis. Fifty-six children (38.1%) weighed less t han 10 kg, and the conversion rate did not correlate with the body weight. There was 1 (0.07%) intraoperative event. A small bowel perforation was ide ntified im mediately and resolved with an uneventful course. Postoperative complications included an incisional hernia in 3 children and an incisional leakage of liquor in 1 child with a ventriculoperitoneal drain. There was a reprolaps after laparoscopic correction of an ileostomy in 1 child and fe ver in another. In 3 newborns the diagnosis was missed during laparoscopy a nd had to be established by laparotomy later with an uneventful course. Pri mary conventional operations were mainly restricted to bower resection and anastomosis performed in 52 of 97 laparotomies. Conclusions: The authors showed that 60% of abdominal operations in childre n can be performed via laparoscopy. Most types of laparoscopic operations a re not performed frequently, but the feasibility of the technique in routin e use is excellent. However, the performance of instruments should be impro ved further, and laparoscopy for establishing the diagnosis in newborns rem ains difficult. J Pediatr Surg 35:1170-1173. Copyright (C) 2000 by W.B. Sau nders Company.