Role of Minimally Invasive Surgery in Management of Penetrating Abdominal Trauma in Children

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.

Efficacy and Safety of Laparoscopy for Mild and Moderate Pediatric Abdominal Trauma: A Systematic Review and Meta-Analysis

“…Among the searched studies, 1314 were excluded because they examined other diseases ( n = 1129), were non-original research studies ( n = 48), did not include or had insufficient information ( n = 58), were written in a non-English language ( n = 19), or were duplicated ( n = 60). Finally, nine studies [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] examining 12,492 patients were included in the present meta-analysis ( Figure 1 ).…”

“…All studies were conducted at children’s hospitals or pediatric trauma centers. Five studies were multicenter trials [ 20 , 22 , 23 , 25 , 27 ]. Evans et al [ 25 ] reported two cohorts derived from a single institution and NTDB; hence, we enrolled both institutional data and nationwide data independently in our meta-analysis.…”

“…Thus, we used only one NTDB cohort [ 25 ]. Six studies [ 19 , 20 , 21 , 22 , 24 , 25 ] compared laparoscopy with laparotomy, whereas three studies [ 23 , 26 , 27 ] reported only laparoscopy. One study [ 26 ] comprised only blunt trauma, and one study [ 27 ] comprised only penetrating trauma.…”

“…Six studies [ 19 , 20 , 21 , 22 , 24 , 25 ] compared laparoscopy with laparotomy, whereas three studies [ 23 , 26 , 27 ] reported only laparoscopy. One study [ 26 ] comprised only blunt trauma, and one study [ 27 ] comprised only penetrating trauma. One study [ 22 ] comprised only grade 3 pancreatic injury, and one study [ 26 ] comprised only blunt liver and spleen injury.…”

“…One study [ 22 ] comprised only grade 3 pancreatic injury, and one study [ 26 ] comprised only blunt liver and spleen injury. The hemodynamic status of the laparoscopic group was stable in eight studies [ 19 , 20 , 21 , 22 , 24 , 25 , 26 , 27 ], whereas one study [ 23 ] did not report the hemodynamic status.…”