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Role of Minimally Invasive Surgery in Management of Penetrating Abdominal Trauma in ChildrenFunding None.
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.
Keywordspenetrating abdominal trauma - children - laparoscopy - minimally invasive surgery - exploratory laparotomy
The study design was approved by the institutional review board and ethical committee and met all the guidelines of their responsible governmental agency. It was performed according to the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. A preliminary version of this article was shared as an oral presentation at the 35th Egyptian pediatric surgical association (EPSA) International First Online Hybrid Congress in Cairo, Egypt, October 22–24, 2020.
M.A.M. and M.A.D. were involved in study conception and design. A.S.S.B. carried out the data acquisition. A.A.H. and A.A. performed data analysis and interpretation. M.A.M. drafted the manuscript. A.A.H., M.H.H., and K.Z.A. dedicated in critical revision. All authors read and approved the final manuscript.
Received: 11 October 2020
Accepted: 16 February 2021
23 March 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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