Use of Laparoscopy in Pediatric Blunt and Spleen Injury: An Unexpectedly Common Procedure After Cessation of Bleeding.
Background: Recently, several series have reported the use of laparoscopy in pediatric trauma, most commonly for bowel and pancreatic injury within the first 12 or 24 hours. During a multicenter trial at 10 Level 1 pediatric trauma centers, selective use of laparoscopy in children with blunt liver or spleen injury (BLSI) was noted. A secondary analysis was performed to describe the frequency and application of these procedures to pediatric BLSI.
Patients and Methods: Prospective data were collected on all children age ≤18 years with BLSI presenting to 1 of 10 pediatric trauma centers. An unplanned secondary analysis of children who underwent laparoscopy was done.
Results: Of 1008 children with BLSI, 59 initially underwent a laparotomy, but 11 underwent a laparoscopic procedure during their index admission; 1 of these was 22 hours postlaparotomy and 2 others were laparoscopy-assisted and converted to laparotomy. Median age of patients undergoing a laparoscopic procedure was 11.5 years (interquartile range [IQR]: 5.8-16.4). Laparoscopy was performed at 7 of the 10 centers. Median time to surgery was 42 hours (IQR: 8-96). Most patients had a liver (n = 6) injury; 4 had spleen and 1 had both. One of the laparoscopies was for pancreatic surgery, and 2 were for bowel injury (but converted to open).
Conclusions: Laparoscopy was utilized in 16% of children requiring abdominal surgery after BLSI, with a median time of 42 hours postinjury. Uses included diagnostic laparoscopy, drain placement, laparoscopic pancreatectomy, and washout of hematoma.
Journal of laparoendoscopic & advanced surgical techniques. Part A
Abdominal Injuries; Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Hemorrhage; Humans; Infant; Infant, Newborn; Laparoscopy; Laparotomy; Liver; Male; Practice Patterns, Physicians'; Retrospective Studies; Spleen; Trauma Centers; United States; Wounds, Nonpenetrating
blunt liver injury; blunt splenic injury; blunt trauma; laparoscopy
Parrado, R., Notrica, D. M., Garcia, N. M., Alder, A. C., Eubanks, J. W., Maxson, R., Letton, R. W., Ponsky, T. A., St Peter, S. D., Leys, C., Bhatia, A., Tuggle, D. W., Lawson, K. A., Ostlie, D. J. Use of Laparoscopy in Pediatric Blunt and Spleen Injury: An Unexpectedly Common Procedure After Cessation of Bleeding. Journal of laparoendoscopic & advanced surgical techniques. Part A 29, 1281-1284 (2019).