P Olivares1, J A Tovar. 1. Departamento de Cirugía Pediátrica, Hospital Infantil Universitario La Paz, Madrid.
Abstract
OBJECTIVE: We summarize our experience in laparoscopic surgery between 1992 and 1997 in an attempt to provide the pediatrician with up-dated information regarding the background, technical basis and limitations of this procedure in children. PATIENTS AND METHODS: For our 315 operations we used conventional endoscopic equipment with miniaturized instruments and regular anesthetic procedures assisted only with on-line capnography and increased tidal volume. Ages ranged between newborn and adolescence and the main indications for surgery were gonadal operations (n = 113), fundoplication (n = 40), cholecystectomy (n = 35), exploration for recurrent abdominal pain (n = 44) and appendectomy (n = 29), but we also performed spleenectomies (n = 7), nephrectomies (n = 6), rectosigmoidectomies (n = 4) and several other procedures. RESULTS: Complications were scares [4 major (1.2% and 17 minor (5.3%)] and were satisfactorily solved. The conversion to an open operation was felt necessary in only 7 instances (2.2%) and this approach has been fully rewarding in terms of good results, little pain, short hospital stay and rapid recovery. CONCLUSIONS: Laparoscopic surgery is already a realistic alternative in pediatric medicine and its indications are growing every day as a result of its widespread use. The pediatrician has to be aware of the opportunity, rationale and limits of this approach since he will be increasingly confronted with it.
OBJECTIVE: We summarize our experience in laparoscopic surgery between 1992 and 1997 in an attempt to provide the pediatrician with up-dated information regarding the background, technical basis and limitations of this procedure in children. PATIENTS AND METHODS: For our 315 operations we used conventional endoscopic equipment with miniaturized instruments and regular anesthetic procedures assisted only with on-line capnography and increased tidal volume. Ages ranged between newborn and adolescence and the main indications for surgery were gonadal operations (n = 113), fundoplication (n = 40), cholecystectomy (n = 35), exploration for recurrent abdominal pain (n = 44) and appendectomy (n = 29), but we also performed spleenectomies (n = 7), nephrectomies (n = 6), rectosigmoidectomies (n = 4) and several other procedures. RESULTS: Complications were scares [4 major (1.2% and 17 minor (5.3%)] and were satisfactorily solved. The conversion to an open operation was felt necessary in only 7 instances (2.2%) and this approach has been fully rewarding in terms of good results, little pain, short hospital stay and rapid recovery. CONCLUSIONS: Laparoscopic surgery is already a realistic alternative in pediatric medicine and its indications are growing every day as a result of its widespread use. The pediatrician has to be aware of the opportunity, rationale and limits of this approach since he will be increasingly confronted with it.