Laparoscopic full-thickness intestinal biopsies in children

Background: Laparoscopy may reduce postoperative pain and hospital stay, co mpared with laparotomy. The use of laparoscopic surgery to obtain full-thic kness intestinal biopsies in children has not been previously reported. Methods: Eleven children aged 1.6 to 19 years (median, 4.5 years) underwent laparoscopic full-thickness biopsy of the stomach, small bowel, colon, or a combination thereof. Each procedure used one 12-mm and two 5-mm ports. Results: Eight children with obstructive symptoms after a pull-through for Hirschsprung disease underwent multiple colon and small bowel biopsies (ran ge, 3-6, median, 5); intestinal neuronal dysplasia was found in two. Two pa tients with cystic fibrosis had diffuse colonic narrowing; a diagnosis of e nzyme-induced fibrosing colonopathy was made in one and nonspecific inflamm ation was found in the other. One child had a thickened stomach, and a gast roscopic-directed full-thickness biopsy revealed plasmacytoma. Nine of the I I patients had a previous laparotomy, and ports were placed through preex isting scars. Median hospital stay was 2 days. No patient required more tha n 24 hours of narcotics, There were no leaks, and no other morbidity or mor tality occurred. None of the patients required conversion to an open proced ure. Biopsy results significantly affected treatment for each patient. Conclusions: Laparoscopic fit I I-thickness intestinal biopsy is safe and e ffective for a variety of gastrointestinal problems in children. This techn ique is associated with a short hospital stay, minimal pain, and a very low risk of complications and can be performed even in patients who have had a previous laparotomy.