Role of laparoscopy in penetrating abdominal trauma in children | Total of 117 patients presented with PAT | 9 (13%) TLs converted to limited laparotomy | 5-year prospective study of kids presenting to the EDs in Egypt & Saudi Arabia with penetrating abdominal trauma (PAT) | 48 gunshot wounds | 69 stab wounds (36 accidental) | All hemodynamically stable | 100% of intra-abdominal injuries identified with laparoscopy | 0 missed injuries | 8 total complications | 0 mortalities | 102 patients underwent laparoscopy | 33.3% diagnostic (DL) - all had peritoneal violation | 66.7% therapeutic (TL) | Conclusion: Laparoscopy has 100% accuracy for diagnosing injuries in PAT | Source: Mahmoud et al, Eur J Pediatr Surg | https://pubmed.ncbi.nlm.nih.gov/33757135/ | @emencisco @EmTombash
Role of laparoscopy in penetrating abdominal trauma in children
Infographic · Oct 2021 · 2 min read
In brief
In brief
Prospective study of 117 hemodynamically stable children with penetrating abdominal trauma found laparoscopy achieved 100% diagnostic accuracy with zero missed injuries. Complete laparoscopic management was possible in 87% of therapeutic cases, with low complication rates and no mortality over 52-month follow-up.
- Laparoscopy achieved 100% accuracy in identifying injured organs with zero missed injuries in 117 stable pediatric PAT cases.
- 86.8% of therapeutic laparoscopy cases were completed without conversion; only 13.2% required limited laparotomy.
- Diagnostic laparoscopy averaged 17 minutes with 2-day hospital stay versus 85 minutes and 5.4 days for therapeutic cases.
- Low complication rate (7.84%) with no mortality across gunshot, stab, and accidental penetrating injuries over 52-month follow-up.
- MIS is safe and effective for hemodynamically stable children with PAT, avoiding unnecessary exploratory laparotomy.
Written by the GCMD Library team from the infographic.
A teal-colored infographic with white and yellow text boxes arranged in a grid layout. The left side features an illustration of paramedics loading a patient into an ambulance. The center and right sections contain statistical data boxes with numerical outcomes. A blue laparoscopic instrument illustration appears in the lower center. Social media handles and source citation are shown at the bottom.
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.