Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children | AMERICAN COLLEGE OF SURGEONS | ACS Trauma Quality Programs data | Retrospective cohort study | 2016-2021 | 1945 patients | underwent abdominal surgery for penetrating trauma within 24 hrs of admission | 32% were stabbed | 68% had gunshot wounds (GSW) | Laparoscopy (LAP): n=235 (12%) | used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < 0.01) | higher use of LAP at pediatric centers (p < 0.01) | Laparoscopy converted to open (LCO): n=145 (7.4%) | Open: n=1565 (80.5%) | more severely injured w/ longer length of stay (p < 0.01) | had more subsequent procedures (11% of open, 2 % LAP, 7% LCO) | No significant difference in mortality or complications by operative type | Conclusion: In stable pediatric patients with penetrating abdominal trauma, LAP is primarily used after stab injuries and at pediatric trauma centers, with low rates of missed injuries and subsequent procedures. Clear criteria are needed to identify patients who may benefit from this approach. | https://pubmed.ncbi.nlm.nih.gov/39490348/ | Patwardhan UM et al. | Naval Medical Center San Diego & Rady Children's Hospital San Diego, San Diego, CA | Journal of Pediatric Surgery | X @EmGooteeMD | X @StayCurrentMD | Cincinnati Children's
Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children
Infographic · Mar 2025 · 1 min read
In brief
In brief
This ACS Trauma Quality Programs study of 1,945 pediatric penetrating abdominal trauma patients found laparoscopy was used in only 12% of cases, primarily for stab wounds at pediatric centers. Laparoscopic patients had shorter hospital stays and fewer subsequent procedures without increased missed injuries, suggesting broader application may be warranted in stable patients.
- Laparoscopy used in only 12% of stable pediatric penetrating abdominal trauma cases, more common with stab wounds (24%) than gunshots (7%)
- Laparoscopic approach showed lower rates of subsequent procedures (2% vs 11% open) with no increase in missed injuries
- Pediatric trauma centers utilize laparoscopy more frequently than general trauma centers for stable penetrating abdominal injuries
- No difference in mortality or complications between laparoscopic and open approaches in hemodynamically stable children
- Standardized criteria needed to identify which stable pediatric penetrating trauma patients benefit most from laparoscopic exploration
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with cartoon illustrations of a clinician and a child patient with an abdominal scar. Data is presented in hierarchical sections with bullet points, percentages, and statistical comparisons. A laparoscopic view image appears in the lower right corner alongside the illustrated surgeon.
Utsav M. Patwardhan, Casey R. Erwin, Alexandra S. Rooney, Bryan Campbell, Benjamin Keller, Andrea Krzyzaniak, Vishal Bansal, Michael J. Sise, Michael J. Krzyzaniak, Romeo C. Ignacio, Jr.
Introduction: In stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients.
Methods: The American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (<18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission. Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) < 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries.
Results: Among 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < .01). There was higher use of LAP at pediatric centers (p < .01). Although there was no difference in mortality or complications by operative type, open patients were more severely injured, had a longer LOS (p < .01), and had more subsequent procedures (11% of open, 2 % LAP, 7% LCO, p < .01).
Conclusion: In stable children with penetrating abdominal trauma, LAP is most often utilized after stabbing and at pediatric trauma centers, but its overall use remains uncommon. LAP patients had lower rates of subsequent procedures and no increase in unexpected operations suggesting low rates of missed injuries. Criteria are needed to identify stable patients presenting after penetrating trauma who can benefit from a LAP approach.