Laparoscopic surgery in neonates and infants weighing less than 5 kg

Background: Laparoscopic surgery in small infants is still an uncommon proc edure in Japan. The present study was conducted to evaluate the advantages and disadvantages of laparoscopic surgery in neonates and infants weighing less than 5 kg. Methods: Between July 1997 and November 1999, 54 infants underwent laparosc opic surgery. They were evaluated for length of operation, intra- and posto perative complications, changes in intra-operative body temperature, time t o postoperative feeding, length of hospital stay and changes in serum level s of C-reactive protein (CRP), creatinine phosphokinase (CPK) and interleuk in (IL)-6 on days 0, 1 and 4. These parameters in the laparoscopic pyloromy otomy (LP) and laparoscopic fundoplication groups were compared with those in the open pyloromyotomy (OP) and open fundoplication groups, respectively , which were performed during the same period. Results: Three laparoscopy cases were converted to open procedures. One cas e of fundoplication had panperitonitis due to failed gastrostomy and requir ed long-term parenteral nutrition. Time to postoperative feeding and length of hospital stay in the LP group were significantly shorter than in the OP group. In LP group, intra-operative body temperature did not markedly decr ease during CO: pneumoperitoneum. Although serum levels of CRP, CPK and IL- 6 were elevated in all groups on postoperative day 1, there were no signifi cant differences between the groups. Conclusions: Better quality of life after laparoscopy is a significant adva ntage over conventional surgical procedures. This advantage not only outwei ghs the incidence of intra- and postoperative complications in small infant s, but further emphasizes the need to improve laparoscopic techniques to av oid complications.