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PURPOSE: Umbilical access in laparoscopic surgery has been cited as a potential factor for increased complications in low birth weight infants and those less than three months old. Previous series noted a self-reported complication rate of 10.6% among 329 pediatric surgeons via anonymous survey, citing carbon dioxide (CO2) embolism as the most common complication. We report four-year outcomes with blunt transumbilical laparoscopic access to examine the safety of this technique. METHODS: Following IRB approval, a retrospective database of patients less than three months of age who underwent laparoscopic pyloromyotomy or inguinal hernia repair from 2016-2019 at a tertiary care academic center was reviewed. Operative reports, anesthesia records, post-operative documentation, and postoperative telephone calls were reviewed for complications related to umbilical access. Complications included bowel injury, bleeding umbilical vessels, umbilical vein cannulation, CO2 embolism, umbilical surgical site infection (SSI), umbilical hernia requiring repair, and death. RESULTS: Three hundred sixty-five patients met criteria for analysis (Table 1); 246 laparoscopic pyloromyotomy and 119 laparoscopic inguinal hernia repairs. Median age at operation was 5.9 weeks [4.3,8.8] and median weight was 3.9 kg [3.4,4.6]. Median operative time was 20 minutes [15,28]. Nine complications occurred for a total complication rate of 2.5%; 5 umbilical SSIs (1.4%), 1 bowel injury upon entry requiring laparoscopic repair (0.2%), 1 umbilical hernia requiring repair at 22 days after surgery (0.2%), and 2 cases of severe hypotension and bradycardia upon insufflation that resolved with exsufflation (0.5%). There were no intraoperative mortalities and no signs or symptoms of CO2 embolism. CONCLUSIONS: In this series umbilical access in laparoscopic surgery in neonates less than three months of age and less than 5kg was safe, with minimal complications.

Publication Date



Pediatrics | Surgery

When and Where Presented

22nd Annual European Pediatric Surgery Association Conference (EUPSA) Athens, Greece September 2-4, 2021

Umbilical Access in Laparoscopic Surgery in Infants less than 3 months: Single Institution Retrospective Review