Use of laparoscopy in the management of pediatric abdominal trauma.

BACKGROUND: Anecdotally, laparoscopy has been used for the diagnosis and therapy of pediatric abdominal trauma, but only few studies have been published. We performed a systematic analysis of our experience concerning indications, procedures, and outcomes using laparoscopy in pediatric abdominal trauma patients.

METHODS: Our trauma database was searched for patients who underwent laparoscopy after being admitted for abdominal trauma. Cases were grouped into diagnostic and therapeutic procedures. Success was defined as attaining the correct diagnosis or as the ability to repair the injury by laparoscopy.

RESULTS: Of 4,836 pediatric trauma admissions over a period of 12 years, 92 had open or laparoscopic abdominal explorations for blunt (n = 47) and penetrating (n = 35) injuries. In 21 patients, diagnostic laparoscopic procedures were performed, and 5 of these children also underwent a therapeutic laparoscopy. Nineteen patients were treated in the acute setting and two in a delayed fashion. Overall, 19 of 21 laparoscopies correctly diagnosed the injury, and all the 5 laparoscopic therapeutic procedures were successful. There was a significant difference in success rate of diagnostic laparoscopy between acute and delayed cases (p < 0.01). Retrospectively, laparotomy was avoided in 13 of 21 patients overall and in 10 of 10 patients with penetrating trauma (p = 0.02).

CONCLUSIONS: Laparoscopy is useful in the management of the hemodynamically stable pediatric patient with abdominal trauma but may be less valuable in cases with delayed presentation. Many intraabdominal injuries are amenable to laparoscopic repair. In patients with penetrating trauma, laparoscopy avoided laparotomy is more likely than in those with blunt abdominal trauma. Laparoscopy is currently underutilized in the management of pediatric abdominal trauma.