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Kankoç A, Sayan M, Çelik A. Videothoracoscopic surgery in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S43-S54. [PMID: 38584793 PMCID: PMC10995678 DOI: 10.5606/tgkdc.dergisi.2024.25710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 04/09/2024]
Abstract
Video-assisted thoracic surgery (VATS) is now being used with increasing frequency for a wide variety of indications in pediatric patients. Although there is no high level of evidence for the advantages of VATS in the pediatric patient group, the proven benefits of this method in the adult patient group have encouraged thoracic surgeons to perform VATS in this patient population. In this study, the procedures performed in pediatric patients under 18 years of age and their results were reviewed with the help of articles obtained as a result of searches using relevant keywords in the English literature (PubMed, Web of Science, EMBASE, and Cochrane). The frequency, indications, and results of the procedures performed differed according to age groups.
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Affiliation(s)
- Aykut Kankoç
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Muhammet Sayan
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ali Çelik
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
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2
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Park YC, Jo YG, Ki YJ, Kang WS, Kim J. Efficacy and Safety of Laparoscopy for Mild and Moderate Pediatric Abdominal Trauma: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11071942. [PMID: 35407550 PMCID: PMC8999532 DOI: 10.3390/jcm11071942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
In this systematic review and meta-analysis, we aimed to investigate the efficacy and safety of laparoscopy for pediatric patients with abdominal trauma. Relevant articles were obtained by searching the MEDLINE PubMed, EMBASE, and Cochrane databases until 7 December 2021. Meta-analyses were performed using odds ratio (OR) for binary outcomes, standardized mean differences (SMDs) for continuous outcome measures, and overall proportion for single proportional outcomes. Nine studies examining 12,492 patients were included in our meta-analysis. Our meta-analysis showed younger age (SMD −0.47, 95% confidence interval (CI) −0.52 to −0.42), lower injury severity score (SMD −0.62, 95% CI −0.67 to −0.57), shorter hospital stay (SMD −0.55, 95% CI −0.60 to −0.50), less complications (OR 0.375, 95% CI 0.309 to 0.455), and lower mortality rate (OR 0.055, 95% CI 0.0.28 to 0.109) in the laparoscopy group compared to the laparotomy group. The majority of patients were able to avoid laparotomy (0.816, 95% CI 0.800 to 0.833). There were no missed injuries during the laparoscopic procedures in seven eligible studies. Laparoscopy for stable pediatric patients showed favorable outcomes in terms of morbidity and mortality. There were no missed injuries, and laparotomy could be avoided for the majority of patients.
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Affiliation(s)
- Yun Chul Park
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Chonnam National University, Gwangju 61469, Korea; (Y.C.P.); (Y.G.J.)
| | - Young Goun Jo
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Chonnam National University, Gwangju 61469, Korea; (Y.C.P.); (Y.G.J.)
| | - Young-Jun Ki
- Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Wu Seong Kang
- Department of Trauma Surgery, Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju 63127, Korea;
- Correspondence:
| | - Joongsuck Kim
- Department of Trauma Surgery, Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju 63127, Korea;
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Gerardo RG, Ponsky TA. Diagnostic Laparoscopy for Abdominal Trauma in Infants and Children: How We Do It. J Laparoendosc Adv Surg Tech A 2021; 31:1224-1226. [PMID: 34520262 DOI: 10.1089/lap.2021.0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although once thought to be a point of contention, the use of minimally invasive surgery for the hemodynamically stable pediatric trauma patients has grown dramatically since its conception in the 1970s and becoming a widely acceptable option for select patient populations. An accumulation of literature over the decades has continued to support laparoscopy for both diagnostic and therapeutic purposes in the pediatric trauma patients as laparoscopy is likely to decrease morbidity, hospital cost, and negative laparotomy rates. In this review, we describe what we believe to be the critical aspects of diagnostic laparoscopy in the setting of pediatric trauma.
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Affiliation(s)
- Rodrigo G Gerardo
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Todd A Ponsky
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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4
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Richards MK, Clifton MS. Minimally invasive surgery of the pancreas: a narrative review of current practice. Transl Gastroenterol Hepatol 2021; 6:38. [PMID: 34423159 DOI: 10.21037/tgh-20-220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022] Open
Abstract
Minimally invasive surgery has moved from the fringe of pediatric surgery to the mainstream to address a variety of problems. Pancreatic pathology, though uncommon and complex, is frequently amenable to laparoscopic intervention. Indications for pediatric pancreatic operative intervention includes trauma, congenital hyperinsulinemia and neoplasm. Children may require distal pancreatectomy, subtotal pancreatectomy, enucleation, lateral pancreaticojejunostomy and pancreaticoduodenectomy. Of these operations, all but pancreaticoduodenectomy have been successfully described in children using a minimally invasive approach. Traumatic transection of the main pancreatic duct may require operative intervention if endoscopic techniques are unsuccessful. Distal pancreatectomy has been successfully utilized in this circumstance. Additionally, near total pancreatectomy may also be performed laparoscopically although successful reports are limited. Enucleation, especially with the use of intraoperative ultrasound may avoid a large laparotomy for isolated benign masses. Finally, chronic pancreatitis resulting in a dilated main pancreatic duct may benefit from a lateral pancreaticojejunostomy. This operation has also successfully been performed in children. Included is a review of pediatric pancreatic minimally invasive operations paired with corresponding pathology.
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Affiliation(s)
- Morgan K Richards
- Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew S Clifton
- Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Mahmoud MA, Daboos MA, Bayoumi ASS, Helal AA, Almaawi A, Hassab MH, Aldaraan KZ. Role of Minimally Invasive Surgery in Management of Penetrating Abdominal Trauma in Children. Eur J Pediatr Surg 2021; 31:353-361. [PMID: 33757135 DOI: 10.1055/s-0041-1726411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Traditionally, exploratory laparotomy was used to treat penetrating abdominal trauma (PAT). At present, minimally invasive surgery (for diagnostic and therapeutic purposes) has developed and represents a rapidly evolving modality for dealing with PAT in stable children. In this article, we aim to present our experience, evaluate the effectiveness, and report the results of minimally invasive surgery (MIS) for PAT in stable pediatric patients. MATERIALS AND METHODS This prospective study involved 117 hemodynamically stable pediatric cases of PAT (caused by gunshots, stab, and accidental stab), admitted, and managed according to the severity of injury. The information recorded for analysis included demographic data, the anatomical location of injury, the initial vital data and scoring systems, the organs affected, the procedures done, operative time, need for conversion to laparoscopic-assisted approach, length of hospital stay, complications, missed injury, and mortality rate. RESULTS Among 117 pediatric patients with PAT, 15 cases were treated conservatively and 102 cases were managed by MIS. They were 70 males and 47 females with a mean age of 7.3 ± 0.6 years (range = 1-14 years). They included 48 cases of gunshot injury, 33 cases of abdominal stab, and 36 cases of accidental stab. Laparoscopy was diagnostic (DL) in 33.3% (n = 34) and therapeutic (TL) in 66.7% (n = 68) of cases. Of the 68 TL cases, we completely managed 59 cases (86.8%) by laparoscopy, while 9 cases (13.2%) were converted to limited laparotomy. The mean operative time was 17 ± 1 minutes (range = 12-25 minutes) for DL, 85 ± 9 minutes (range = 41-143 minutes) for complete TL cases, and 89 ± 3 minutes (range = 47-149 minutes) for laparoscopic-assisted procedures. For DL cases, the mean length of hospital stay was 2 ± 0.4 days, while for complete TL cases, it was 5.4 ± 0.83 days, and for laparoscopic-assisted cases, it was 5.8 ± 0.37 days. Postoperative complications occurred in eight cases (7.84%), with five cases (4.9%) required reintervention. No missed injury or mortality was recorded in the study. The patients were followed up for a median period of 52 months. CONCLUSION For management of PAT in children, MIS has 100% accuracy in defining the injured organs with zero percent missed injuries.
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Affiliation(s)
- Muhammad Abdelhafez Mahmoud
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.,Department of Pediatric Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Mohammad Alsayed Daboos
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.,Department of Pediatric Surgery, Maternity and Children's Hospital, Bisha, Saudi Arabia
| | | | | | - Abdulrahman Almaawi
- Department of Pediatric Surgery, Maternity and Children's Hospital, Bisha, Saudi Arabia
| | - Mohamed Hany Hassab
- Department of Pediatric Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Khaled Zamel Aldaraan
- Department of Pediatric Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
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Butler EK, Mills BM, Arbabi S, Groner JI, Vavilala MS, Rivara FP. Laparoscopy Compared With Laparotomy for the Management of Pediatric Blunt Abdominal Trauma. J Surg Res 2020; 251:303-310. [PMID: 32200321 PMCID: PMC7247932 DOI: 10.1016/j.jss.2020.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/03/2020] [Accepted: 01/25/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is minimal evidence evaluating the risks and benefits of laparoscopy use in hemodynamically stable children with suspected abdominal injuries. The objective of this study was to evaluate postoperative outcomes in a large cohort of hemodynamically stable pediatric patients with blunt abdominal injury. METHODS Using the 2015-2016 National Trauma Data Bank, all patients aged <18 y with injury severity score (ISS) ≤25, Glasgow coma scale ≥13, and normal blood pressure who underwent an abdominal operation for blunt abdominal trauma were included. Patients were grouped into three treatment groups: laparotomy, laparoscopy, and laparoscopy converted to laparotomy. Treatment effect estimation with inverse probability weighting was used to determine the association between treatment group and outcomes of interest. RESULTS Of 720 patients, 504 underwent laparotomy, 132 underwent laparoscopy, and 84 underwent laparoscopy converted to laparotomy. The median age was 10 (IQR: 7-15) y, and the median ISS was 9 (IQR: 5-14). Mean hospital length of stay was 2.1 d shorter (95% confidence interval [CI]: 0.9-3.2 d) and mean intensive care unit length of stay was 1.1 d shorter (95% CI: 0.6-1.5 d) for the laparoscopy group compared with the laparotomy group. The laparoscopy group had a 2.0% lower mean probability of surgical site infection than the laparotomy group (95% CI: 1.0%-3.0%). CONCLUSIONS In this cohort of hemodynamically stable pediatric patients with blunt abdominal injury, laparoscopy may have improved outcomes over laparotomy.
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Affiliation(s)
- Elissa K Butler
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Surgery, University of Washington, Seattle, Washington.
| | - Brianna M Mills
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Surgery, University of Washington, Seattle, Washington
| | - Jonathan I Groner
- Center for Pediatric Trauma Research, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
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7
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Evans PT, Phelps HM, Zhao S, Van Arendonk KJ, Greeno AL, Collins KF, Lovvorn HN. Therapeutic laparoscopy for pediatric abdominal trauma. J Pediatr Surg 2020; 55:1211-1218. [PMID: 31350042 PMCID: PMC6960361 DOI: 10.1016/j.jpedsurg.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/29/2019] [Accepted: 07/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND For the surgical treatment of traumatic hollow viscus injuries, laparoscopy offers a potentially less morbid approach to open exploration among appropriately selected patients. This study aimed to evaluate utilization trends and efficacy of laparoscopy in the management of pediatric abdominal trauma. STUDY DESIGN To gain both study granularity and power, our institutional trauma registry (2005-2017) and the National Trauma Data Bank (NTDB; 2010-2015) identified patients ≤18 years who required celiotomy for abdominal trauma. Injury mechanisms, patient characteristics, and hospital courses were compared between open and laparoscopic approaches. Unadjusted and adjusted statistical analyses were performed. RESULTS Overall, data were similar among 393 institutional and 11,399 NTDB patients undergoing laparoscopic (n = 88, 22%; n = 1663, 16%) or open (n = 305, 78%; n = 9736, 85%) surgery for abdominal trauma. In both registries, laparoscopy was more commonly employed in younger (institutional p = 0.026; NTDB p < 0.001) female (p = 0.019; p < 0.001) patients having lower injury severity (p < 0.001) and blunt injuries (p = 0.031; p < 0.001). Laparoscopy was associated with fewer complications overall when adjusting for demographics and injury severity [institutional OR 0.25 (0.08-0.75), p = 0.013; NTDB OR 0.69 (0.55-0.88), p = 0.002]. An increase in utilization of MIS for pediatric abdominal trauma was detected over time (NTDB: r = 0.88, p = 0.02). CONCLUSION For the management of pediatric abdominal trauma, laparoscopy was employed typically in younger, more stable, and female patients sustaining blunt injuries. Appropriately selected patients have similar or better outcomes to patients treated with laparotomy, with no increase in adverse events or missed injuries. Increased utilization of laparoscopy to manage abdominal trauma in children suggests greater acceptance of this approach. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Hannah M. Phelps
- Vanderbilt University School of Medicine, Nashville, TN,Surgical Outcomes Center for Kids, Vanderbilt University, Nashville, TN
| | - Shilin Zhao
- Surgical Outcomes Center for Kids, Vanderbilt University, Nashville, TN,Center for Quantitative Sciences, Vanderbilt University, Nashville, TN
| | - Kyle J. Van Arendonk
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amber L. Greeno
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kelly F. Collins
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Harold N. Lovvorn
- Surgical Outcomes Center for Kids, Vanderbilt University, Nashville, TN,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
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8
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Train AT, Naseem HUR, Chen Z, Wilding GE, Bass KD, Noyes K, Train WW, Rothstein DH. Predictors and Outcomes of Laparoscopy in Pediatric Trauma Patients: A Retrospective Cohort Study. J Laparoendosc Adv Surg Tech A 2019; 29:1598-1604. [PMID: 31687886 DOI: 10.1089/lap.2019.0322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Laparoscopy has been shown to offer a safe alternative to laparotomy in hemodynamically stable pediatric trauma patients. Our purpose was to identify factors predictive of this approach and examine surgical outcomes. Methods: This is a retrospective cohort study using the ACS Pediatric Trauma Quality Improvement Program to examine pediatric patients who underwent exploration for blunt or penetrating abdominal trauma in 2014 and 2015. Patients with contraindications to laparoscopy were excluded. Multivariable modeling identified predictors of a laparoscopic approach. Secondary analysis assessed differences in outcomes and resource utilization between laparoscopy and laparotomy groups. Results: A total of 160 patients met inclusion criteria. Patients undergoing surgery in the northeastern (odds ratio [OR]: 2.25, 95% confidence interval [CI]: 1.26-4.03, P = .006) and western (OR: 2.03, 95% CI: 1.06-3.88, P = .032) U.S. regions had over two times greater odds of undergoing laparoscopy as those treated in the south. Patients injured by a firearm were significantly less likely to undergo laparoscopy than those suffering blunt injury (OR: 0.27, 95% CI: 0.13-0.55, P < .001). After adjustment, patients explored laparoscopically in comparison with those through laparotomy had decreased average length of stay (LOS) (mean difference [MD]: 2.55 days, 95% CI: 1.19-3.90, P < .001) and number of intensive care unit (ICU) days (MD: 1.13 days, 95% CI: 0.28-1.98, P = .01). Conclusion: Trauma laparoscopy may decrease LOS and ICU days in select pediatric patients requiring abdominal exploration; however, laparoscopy is not uniformly practiced in the United States. Targeted education and protocols for initial use of laparoscopy should be incorporated into hospitals treating this group to minimize morbidity and resource utilization.
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Affiliation(s)
- Arianne T Train
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Hibbit-Ur-Rauf Naseem
- Department of Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Ziquiang Chen
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, New York
| | - Gregory E Wilding
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, New York
| | - Kathryn D Bass
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
- Department of Pediatric Surgery, Oishei Children's Hospital, Buffalo, New York
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York School of Public Health and Health Professions, Buffalo, New York
| | - William W Train
- Department of Surgery, Memorial Health University Medical Center, Savannah, Georgia
| | - David H Rothstein
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
- Department of Pediatric Surgery, Oishei Children's Hospital, Buffalo, New York
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Parrado R, Notrica DM, Garcia NM, Alder AC, Eubanks JW, Maxson RT, Letton RW, Ponsky TA, St Peter SD, Leys C, Bhatia A, Tuggle DW, Lawson KA, Ostlie DJ. Use of Laparoscopy in Pediatric Blunt and Spleen Injury: An Unexpectedly Common Procedure After Cessation of Bleeding. J Laparoendosc Adv Surg Tech A 2019; 29:1281-1284. [PMID: 31397620 DOI: 10.1089/lap.2019.0160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Recently, several series have reported the use of laparoscopy in pediatric trauma, most commonly for bowel and pancreatic injury within the first 12 or 24 hours. During a multicenter trial at 10 Level 1 pediatric trauma centers, selective use of laparoscopy in children with blunt liver or spleen injury (BLSI) was noted. A secondary analysis was performed to describe the frequency and application of these procedures to pediatric BLSI. Patients and Methods: Prospective data were collected on all children age ≤18 years with BLSI presenting to 1 of 10 pediatric trauma centers. An unplanned secondary analysis of children who underwent laparoscopy was done. Results: Of 1008 children with BLSI, 59 initially underwent a laparotomy, but 11 underwent a laparoscopic procedure during their index admission; 1 of these was 22 hours postlaparotomy and 2 others were laparoscopy-assisted and converted to laparotomy. Median age of patients undergoing a laparoscopic procedure was 11.5 years (interquartile range [IQR]: 5.8-16.4). Laparoscopy was performed at 7 of the 10 centers. Median time to surgery was 42 hours (IQR: 8-96). Most patients had a liver (n = 6) injury; 4 had spleen and 1 had both. One of the laparoscopies was for pancreatic surgery, and 2 were for bowel injury (but converted to open). Conclusions: Laparoscopy was utilized in 16% of children requiring abdominal surgery after BLSI, with a median time of 42 hours postinjury. Uses included diagnostic laparoscopy, drain placement, laparoscopic pancreatectomy, and washout of hematoma.
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Affiliation(s)
- Raphael Parrado
- Level I Pediatric Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - David M Notrica
- Level I Pediatric Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Nilda M Garcia
- Pediatric Trauma Center, Dell Children's Medical Center, Austin, Texas
| | - Adam C Alder
- Pediatric Surgery Department, Children's Medical Center, Dallas, Texas
| | - James W Eubanks
- Department of Pediatric Surgery, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - R Todd Maxson
- Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Robert W Letton
- Department of Surgery, The Children's Hospital at OU Medical Center, Oklahoma City, Oklahoma
| | - Todd A Ponsky
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, Ohio
| | - Shawn D St Peter
- Pediatric Surgery, Mercy Children's Hospital, Kansas City, Missouri
| | - Charles Leys
- Pediatric Surgery, American Family Children's Hospital, Madison, Wisconsin
| | - Amina Bhatia
- Department of Pediatric Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - David W Tuggle
- Pediatric Trauma Center, Dell Children's Medical Center, Austin, Texas
| | - Karla A Lawson
- Pediatric Trauma Center, Dell Children's Medical Center, Austin, Texas
| | - Daniel J Ostlie
- Level I Pediatric Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona
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Kleanthis A, Mouravas V, Lampropoulos V, Babatseva E, Spyridakis I. Laparoscopic evaluation and management of isolated gastric rupture in a boy after blunt abdominal injury. Pan Afr Med J 2017; 27:173. [PMID: 28904701 PMCID: PMC5579448 DOI: 10.11604/pamj.2017.27.173.12430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022] Open
Abstract
Blunt abdominal injury in children can be a significant diagnostic and therapeutic challenge. The extent and localization of organ damage cannot be always thoroughly investigated noninvasively and in spite of modern imaging techniques and a laparotomy may be necessary for diagnosis, even though it carries a significant morbidity. We present a rare case of isolated gastric rupture after blunt abdominal injury in a 12 year old boy that sustained a bicycle accident. He was hemodynamically stable, had signs of acute abdomen and axial tomography was inconclusive as of the site of visceral perforation. Definitive diagnosis and treatment were carried out laparoscopically with excellent results. Laparoscopic surgery in cases of blunt abdominal injury with gastric rupture can serve both as a diagnostic and therapeutic modality with the additional advantage of being less traumatic. The accumulation of relevant experience is mandatory in order to establish this modality in the diagnostic and therapeutic protocols.
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Affiliation(s)
- Anastasiadis Kleanthis
- Paediatric Surgeon, 2 Department of Paediatric Surgery, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Vasilis Mouravas
- Paediatric Surgeon, 2 Department of Paediatric Surgery, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Vasilis Lampropoulos
- Paediatric Surgeon, 2 Department of Paediatric Surgery, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Evgenia Babatseva
- Paediatrician, Neonatologist, 2 Department of Neonatal Intensive Care, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Ioannis Spyridakis
- Assistant Professor, Chief of the 2 Department of Paediatric Surgery, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
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Abstract
Pediatric thoracic trauma is relatively uncommon but results in disproportionately high levels of morbidity and mortality when compared with other traumatic injuries. These injuries are often more devastating due to differences in children׳s anatomy and physiology relative to adult patients. A high index of suspicion is of utmost importance at the time of presentation because many significant thoracic injuries will have no external signs of injury. With proper recognition and management of these injuries, there is an associated improved long-term outcome. This article reviews the current literature and discusses the initial evaluation, current management practices, and future directions in pediatric thoracic trauma.
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Affiliation(s)
- Erik G Pearson
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | - Matthew T Santore
- Section of Pediatric Surgery, Department of Surgery, Children׳s Healthcare of Atlanta, Emory University School of Medicine, Third Floor Surgical Offices, 1405 Clifton Rd, Atlanta, Georgia 30322.
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12
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Pearson EG, Clifton MS. The Role of Minimally Invasive Surgery in Pediatric Trauma. Surg Clin North Am 2017; 97:75-84. [DOI: 10.1016/j.suc.2016.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Stringel G, Xu ML, Lopez J. Minimally Invasive Surgery in Pediatric Trauma: One Institution's 20-Year Experience. JSLS 2016; 20:JSLS.2015.00111. [PMID: 26877626 PMCID: PMC4744998 DOI: 10.4293/jsls.2015.00111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Minimally invasive surgery (MIS) for trauma in pediatric cases remains controversial. Recent studies have shown the validity of using minimally invasive techniques to decrease the rate of negative and nontherapeutic laparotomy and thoracotomy. The purpose of this study was to evaluate the diagnostic accuracy and therapeutic options of MIS in pediatric trauma at a level I pediatric trauma center. Methods: We reviewed cases of patients aged 15 years and younger who had undergone laparoscopy or thoracoscopy for trauma in our institution over the past 20 years. Each case was evaluated for mechanism of injury, computed tomographic (CT) scan findings, operative management, and patient outcomes. Results: There were 23 patients in the study (16 boys and 7 girls). Twenty-one had undergone diagnostic laparoscopy and 2 had had diagnostic thoracoscopy. In 16, there were positive findings in diagnostic laparoscopy. Laparoscopic therapeutic interventions were performed in 6 patients; the remaining 10 required conversion to laparotomy. Both patients who underwent diagnostic thoracoscopy had positive findings. One had a thoracoscopic repair, and the other underwent conversion to thoracotomy. There were 5 negative diagnostic laparoscopies. There was no mortality among the 23 patients. Conclusions: The use of laparoscopy and thoracoscopy in pediatric trauma helps to reduce unnecessary laparotomy and thoracotomy. Some injuries can be repaired by a minimally invasive approach. When conversion is necessary, the use of these techniques can guide the placement and size of surgical incisions. The goal is to shift the paradigm in favor of using MIS in the treatment of pediatric trauma as the first-choice modality in stable patients.
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Affiliation(s)
| | - Min Li Xu
- New York Medical College, Valhalla, New York
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14
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Abstract
PURPOSE OF REVIEW Nonoperative management of pediatric blunt abdominal injury has changed significantly in the last few years. RECENT FINDINGS Improved resource utilization in the diagnosis of pediatric abdominal injury has been described. Hemodynamic status, rather than grade of injury, now guides care. Stable patients spend less time in the hospital, return to school upon discharge, and are allowed lower hemoglobin levels prior to transfusion. ICUs are reserved for those with recent or ongoing bleeding, previously unstable patients, or children with concomitant injuries necessitating ICU. Risk factors for failure and evidence for adjuncts to nonoperative management are emerging. Operative management of certain pancreatic injuries may have more favorable outcomes than nonoperative management. SUMMARY Sufficient evidence has become available to radically change the management of pediatric abdominal injury, which is being incorporated into new evidence-based management algorithms.
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Horkan DB, Tashiro J, Wagenaar AE, Perez EA. Laparoscopy in Pediatric Trauma: The Advancement of Minimally Invasive Techniques for Abdominal Trauma. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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