Laparoscopic Outcomes for Pelvic Pathology in Children and Adolescents among Patients Presenting to the Pediatric and Adolescent Gynecology Service

Abstract

Study ObjectiveThe aim of this study was to evaluate surgical indications, outcomes, and common pelvic pathologies presenting to the Pediatric and Adolescent Gynecology service in premenarcheal (PMF) and menarcheal females (MF) undergoing laparoscopic surgery. DesignA retrospective chart review. SettingAn academic children's hospital. ParticipantsFemales under 21 years of age, excluding pregnant patients, who underwent laparoscopic surgery for a gynecologic indication presenting to the Pediatric and Adolescent Gynecology service at a single children's hospital between July 2007 and January 2012, identified by CPT codes. Main Outcome MeasuresPertinent patient demographics, indication for surgery, anesthesia time, estimated blood loss, surgical instruments used, intra-operative findings, surgical pathology, complications, length of stay, and concerns at follow-up appointment. Descriptive statistics and chi-square analyses of data were performed using SAS 9.3. ResultsOf 158 cases meeting inclusion criteria, 33 patients were PMF (mean age 8.6 ± 3.2 years) and 125 patients were MF (mean age 14.7 ± 2.3 years). Acute abdominal pain was the most common surgical indication in both groups, but was significantly more likely to be the surgical indication in the PMF group (62.7% vs 52.8%, P = .006). Adnexal torsion was more likely to be present in the PMF group than in the MF group (66.7% vs 27.2%, P < .0001). No complications were reported in the PMF group. Two minor complications were reported in the MF group. ConclusionMinimally invasive surgical techniques represent a safe and well-tolerated method for treating a wide variety of pelvic pathology in both younger children and older adolescent females. For physicians evaluating premenarcheal females with acute-onset abdominal pain, adnexal torsion should be prominent among the differential diagnoses.