Abstract
Introduction Abdominal injuries are common, costly, deadly, and a source of considerable uncertainty
in pediatric trauma. In some circumstances, laparoscopy offers a diagnostic and therapeutic
alternative with less morbidity than standard exploration, and more certainty than
most imaging. In this study, we review our experience with laparoscopic exploration
for trauma. We hypothesized that laparoscopy could be employed effectively in stable
blunt or penetrating trauma patients in whom diagnostic uncertainty was unresolved
by imaging.
Patients and Methods A retrospective review of the trauma database identified all children admitted to
our Level I pediatric trauma center between January 1, 2000, and December 31, 2012,
requiring surgical abdominal exploration. The utilization of laparoscopy and laparotomy
was charted over the 13-year period. Negative laparoscopies and laparotomies and nontherapeutic
laparoscopies and laparotomies were examined to investigate clinical scenarios in
which laparotomy might have been avoided. Statistical analyses were performed using
descriptive statistics, simple linear regression analysis, and Mann–Whitney U test (p < 0.05).
Results Over the 13-year study period, there were 16,321 trauma admissions. Of these, 119
patients (0.7%) required surgical abdominal exploration: 81 patients underwent laparotomy
and 38 patients underwent laparoscopy. In 13 patients (34.2%), laparoscopic exploration
ruled out injuries. In nine patients (23.7%), laparoscopy identified an injury for
which no surgical intervention was necessary. In nine patients (23.7%), an injury
was repaired laparoscopically. In seven cases (18.4%), the identified injury required
conversion to laparotomy. There were no missed injuries. In the laparotomy group,
a less invasive approach could have yielded the same information in 8.7% of patients.
Laparoscopy was more likely to be used after a qualitative change in institutional
minimally invasive surgical capability.
Conclusion Laparoscopy reliably resolves diagnostic uncertainty in selected cases of pediatric
abdominal blunt and penetrating trauma. In a hemodynamically stable patient with a
concerning exam and inconclusive imaging, laparoscopy provides sensitive diagnostic
capability and opportunity for definitive repair with diminished surgical morbidity.
Keywords
laparoscopy - pediatric - abdominal trauma
