Laparoscopic Surgery In Children Research Articles

Comparison of Deep and Moderate Neuromuscular Blockade for Major Laparoscopic Surgery in Children: A Randomized Controlled Trial.

Neuromuscular blocking agents are routinely used in laparoscopic surgery to optimize operative conditions. We compared the effect of a deep and moderate neuromuscular blockade (NMB) on surgical conditions and postoperative outcomes in children undergoing major laparoscopic surgery. Sixty children aged 2-14 years scheduled to undergo major laparoscopic surgery were randomly allocated to deep (post-tetanic count 1-2 twitches) or moderate (train-of-four 1-2 twitches) NMB groups. The anesthesia was maintained with propofol and remifentanil, and the NMB was maintained with a rocuronium continuous infusion. At the end of the operation, the NMB were antagonized with sugammadex. The intra-abdominal pressure, airway pressure, Leiden Surgical Rating Scale, intraoperative hemodynamics, drug usages, duration of surgery, postoperative recovery time, pain, and complications were compared between the groups. The maximum and mean intra-abdominal pressure, the peak inspiratory pressure, and mean airway pressure were significantly lower in the deep NMB group than in the moderate NMB group (p < 0.001). The Leiden Surgical Rating Scale and the dosage of rocuronium were significantly higher in the deep NMB group than the moderate NMB group (p < 0.001). The intraoperative hemodynamics, duration of surgery, post-operative recovery time, pain, and the incidence rate of complications were not significantly different between the groups (p > 0.05). A deep NMB provided better operative conditions and similar recovery profiles compared with a moderate NMB as reversed with sugammadex in children undergoing major laparoscopic surgery. Chinese Clinical Trial Registry, No. ChiCTR2100053821.

Effect of ultrasound-guided transversus abdominis plane block in reducing atelectasis after laparoscopic surgery in children: A randomized clinical trial

BackgroundAtelectasis is a commonly observed postoperative complication of general anesthesia in children. Pulmonary protective ventilation strategies have been reported to have a beneficial effect on postoperative atelectasis in children. Therefore, the present study aimed to evaluate the efficacy of the ultrasound-guided transversus abdominis plane (TAP) block technique in preventing the incidence of postoperative atelectasis in children. Materials and methodsThis study enrolled 100 consecutive children undergoing elective laparoscopic bilateral hernia repair and randomly divided them into the control and TAP groups. Conventional lung-protective ventilation was initiated in both groups after the induction of general anesthesia. The children in the TAP group received an ultrasound-guided TAP block with 0.3 mL/kg of 0.5% ropivacaine after the induction of anesthesia. ResultsAnesthesia-induced atelectasis was observed in 24% and 84% of patients in the TAP (n = 50) and control (n = 50) groups, respectively, before discharge from the post-anesthetic care unit (T3; PACU) (odds ratio [OR], 0.062; 95% confidence interval [CI], 0.019–0.179; P < 0.001). No significant difference was observed between the control and TAP groups in terms of the lung ultrasonography (LUS) scores 5 min after endotracheal intubation (T1). However, the LUS scores were lower in the TAP group than those in the control group at the end of surgery (T2, P < 0.01) and before discharge from the PACU (T3, P < 0.001). Moreover, the ace, legs, activity, cry and consolability (FLACC) pain scores in the TAP group were lower than those in the control group at each postoperative time point. ConclusionUltrasound-guided TAP block effectively reduced the incidence of postoperative atelectasis and alleviated pain in children undergoing laparoscopic surgery.

Investigation of Encountered Problems After Laparoscopic Surgery in Children

Aim: This study was planned to determine the problems and affecting factors that children encounter at hospital and at home after laparoscopic surgery.&#x0D; Materials and Methods: This study was conducted in accordance with the descriptive cross-sectional study type in order to determine the post-operative conditions in hospital and home problems and factors affecting the operation of the study. The study was carried out on the patients of pediatric service of whom had laparoscopic surgery. Pre-operative and post-operative descriptive features form, which was developed according to literature by researchers as data collection tool, was collected by using a diagnosis form for problems occurred at home after discharge and for problems occurred in hospital after surgery. &#x0D; Results: It was found in the study that 54.5% of the children were male, 90.9% were gastrointestinal system surgeons and 65.4% were acute appendectomies. It was determined that most of the problems the children lived in hospital and at home was pain.&#x0D; Conclusion: This study will contribute to the planning of nursing interventions that will be useful for the identification, prevention and early identification of the problems that children experience both at home and in the hospital, after the surgery, and to determine the maintenance criteria.

The Comparison of Postoperative Umbilical Port Site-Related Complications Between Transumbilical and Periumbilical Incision After Laparoscopic Surgery in Children.

Introduction: No studies have directly compared postoperative umbilical port site (UPS)-related complications between transumbilical and periumbilical incisions (TUI and PUI) after laparoscopic surgery in children. Patients and Methods: We conducted a retrospective review of 324 children of ≤15 years of age who underwent laparoscopic repair (LR) for inguinal hernia, via either a TUI or PUI, between 2010 and 2020. UPS-related complications, such as wound infection and umbilical deformity, were compared between TUI and PUI. We also investigated the risk factors for the development of UPS-related complications after LR. Results: TUIs and PUIs were used for 228 and 96 children, respectively. The incidence rates of postoperative wound infection and umbilical deformity in the PUI group were higher in comparison to the TUI group; although not to a statistically significant extent (7.3% versus 5.3%, P = .451, 6.3% versus 4.8%, P = .593). One case of incisional hernia at the UPS was seen in the TUI group. In the univariate analysis, sex, age, weight for age Z-score, nutrition status, insertion and closure time, total operative time, American Society of Anesthesiologists score, blood loss, and comorbidities were not significantly associated with the development of UPS-related complications after LR. Conclusion: The incidence of UPS-related complications in TUI and PUI was not significantly different. Due to the low incidence of UPS-related complications, it was difficult to draw conclusions regarding contributing factors; however, meticulous care should be taken to avoid UPS-related complications when closing the UPS (Ethical approval No. 2019-24).

Noninvasive carbon dioxide monitoring in pediatric patients undergoing laparoscopic surgery: transcutaneous vs. end-tidal techniques

PurposeThe present study aimed to investigate the correlation between transcutaneous carbon dioxide partial pressure (PtcCO2) and arterial carbon dioxide pressure (PaCO2) and the accuracy of PtcCO2 in predicting PaCO2 during laparoscopic surgery in pediatric patients.MethodsChildren aged 2–8 years with American Society of Anesthesiologists (ASA) class I or II who underwent laparoscopic surgery under general anesthesia were selected. After anesthesia induction and tracheal intubation, PtcCO2 was monitored, and radial arterial catheterization was performed for continuous pressure measurement. PaCO2, PtcCO2, and end-tidal carbon dioxide partial pressure (PetCO2) were measured before pneumoperitoneum, and 30, 60, and 90 min after pneumoperitoneum, respectively. The correlation and agreement between PtcCO2 and PaCO2, PetCO2, and PaCO2 were evaluated.ResultsA total of 32 patients were eventually enrolled in this study, resulting in 128 datasets. The linear regression equations were: PtcCO2 = 7.89 + 0.82 × PaCO2 (r2 = 0.70, P < 0.01); PetCO2 = 9.87 + 0.64 × PaCO2 (r2 = 0.69, P < 0.01). The 95% limits of agreement (LOA) of PtcCO2 – PaCO2 average was 0.66 ± 4.92 mmHg, and the 95% LOA of PetCO2 – PaCO2 average was –4.4 ± 4.86 mmHg. A difference of ≤ 5 mmHg was noted between PtcCO2 and PaCO2 in 122/128 samples and between PetCO2 and PaCO2 in 81/128 samples (P < 0.01).ConclusionIn pediatric laparoscopic surgery, a close correlation was established between PtcCO2 and PaCO2. Compared to PetCO2, PtcCO2 can estimate PaCO2 accurately and could be used as an auxiliary monitoring indicator to optimize anesthesia management for laparoscopic surgery in children; however, it is not a substitute for PetCO2.Registration number of Chinese Clinical Trial RegistryChiCTR2100043636.

Anesthetic prediction model in laparoscopic surgery in children

Our study analyzes anesthesia with sevofluran through the prism of 5 regress models on the results of 5 anesthetic parameters, systolic pressure, diastolic pressure, pulse, respiratory frequency, oxygen saturation in the blood periferic. For the elaboration of the optimal model carried out a selection of 5 main approximation functions, including linear, logarithmic, exponential, power, polynom. A correlation analysis of the effect of Sevoflurane on all anesthetic parameters was performed. The regression model with the polynom function most accurately reflects the real situation. During laparoscopic intervention, 3 anesthesiologist parameters turned out to be informative, namely systolic pressure, pulse, respiratory rate. Sevoflurane has a significant effect on the pulse (the first place in the power of influence), on systolic pressure (the second place), on respiratory frequency (third place). Graphically, the dynamics of all optimal models with the result of the coefficient of determination is presented in detail.

Abstract No.: ABS3339: Effects of volume controlled and pressure controlled volume guaranteed modes of ventilation on respiratory dynamics during laparoscopic surgery in children: A prospective observational study

Background & Aims:The aim of the study was to compare the effects of Volume controlled ventilation (VCV) and Pressure controlled volume guaranteed ventilation (PCV-VG), which delivers the target tidal volume at the lowest possible pressure, on respiratory dynamics during paediatric laparoscopic surgery.Methods:In this prospective observational study, 52 patients of 0-15 years were included; (n= 26) each for VCV and PCV-VG.fraction of inspired oxygen(FiO2)50%, tidal volume 6-10 ml/kg, age appropriate respiratory rate (RR) to maintain end-tidal carbon dioxide (EtCO2) between 35-40 mm Hg, PEEP 4 cm and P-limit 10 cm above the initial peak pressure were set. Peak inspiratory pressure (PIP), Plateau pressure (PlatP), expiredtidal volume (VTe)/kg, compliance (Compl), airway resistance (R), ETCO2 and saturation of O2 (SaO2)were noted after intubation, creation of pneumoperitoneum, changing position, desufflation and change of position to supine.Results:Demographic criteria, haemodynamic parameters, set and measured respiratory parameters at all time points were similar inboth groups. Trendelenburg position was required in 11 children in VCV and 13 in PCV-VG group. Following this, there was similar increase in PIP, PlatP, R and decrease in CompL in both groups. However, significant increase in RR was required inVCV group (percentage change in RR- —VCV: 3.5±5.01, PCV-VG : 0±00, p=0.039) to maintain normal ETCO2.Conclusion:Either VCV or PCV-VG mode of ventilation, can be used during paediatric laparoscopic surgery in supine position.However, with Trendelenburg position, PCV-VG provides a marginal advantage over VCV mode of ventilation.

Effect of two different levels of positive end-expiratory pressure (PEEP) on oxygenation and ventilation during pneumoperitoneum for laparoscopic surgery in children: A randomized controlled study.

Positive end-expiratory pressure (PEEP) is used to attenuate the changes in respiratory parameters because of pneumoperitoneum during laparoscopic (LAP) surgery. As the ideal level of PEEP during LAP in children is not known, this study compared the effect of 5- and 10-cm H2O of PEEP on oxygenation, ventilator, and hemodynamic parameters during pediatric LAP. After obtaining approval from the Institute Ethics Committee and written informed parental consent, 30 American Society of Anesthesiologists (ASA) I and II children aged 2-10 years, undergoing LAP were randomized to receive PEEP of 5- or 10-cm H2O during pneumoperitoneum. Baseline hemodynamic and ventilatory parameters, PaO2, and PaCO2 were measured 2 min after tracheal intubation, 2 min and 1 h after pneumoperitoneum, and after deflation of pneumoperitoneum. Oxygenation index, dynamic compliance, and alveolar-arterial oxygen gradient (D (A-a) O2) were calculated at the above-mentioned time points. Data were analyzed using Student's t-test and repeated measures ANOVA with Bonferroni correction. The oxygenation index and D(A-a)O2 decreased in PEEP 5 Group and increased in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being statistically significant (P = 0.001). The dynamic compliance decreased in PEEP 5 Group and increased or remained the same in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being significant (P = 0.001). There were no significant changes in the hemodynamic parameters in the two groups. Use of 10-cm H2O PEEP during pneumoperitoneum in children improves ventilation and oxygenation, without significant hemodynamic changes.

Effects of different plasma target concentrations of remifentanil on the MACBAR of sevoflurane in children with laparoscopic surgery

BackgroundTo investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy.MethodsSeventy-five children with 3-7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R0, group R1, and group R2 according to different remifentanil plasma target concentration (0, 1, and 2 ngml-1), respectively. The MACBAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points.ResultsA total of 52 child patients were used among the anticipated 75 patients. In groups R0, R1, and R2, the MACBAR of sevoflurane was (3.29 ± 0.17) %, (2.12 ± 0.10) % and (1.29 ± 0.11) %, respectively, and a significant difference was found among the three groups (P<0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences.ConclusionRemifentanil by target-controlled infusion can effectively reduce the MACBAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MACBAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations.Trial registrationThe trial was registered at http://www.chictr.org.cn(ChiCTR1800019393, 8, Nov, 2018).

How to choose a suitable intraabdominal pressure level during single-incision laparoscopic surgery in children

Laparoscopic surgery has become a common procedure in pediatric patients. However, adverse hemodynamic changes such as the increase of intraabdominal pressure (IAP) may occur laparoscopic surgery. The aim of this study is find a method to set a suitable IAP level in children before laparoscopic surgery. From Jan 2012 to Dec 2014, data were collected from a total of 1776 children needing laparoscopic high ligation of hernia sac. A retrospective data analysis was performed using a new defined variant Index A which had information of age, body mass index (BMI) and duration of pneumoperitoneum. The blood pressures (SBP and DBP) and the PaCO2 were increased but SV showed no changes in patients after CO2 insufflation. The complications were found in 32 cases including 2 cases with subcutaneous emphysemarelated to the CO2 insufflation directly, 3 cases of respiratory infection, 5 cases of incision infection and 2 cases of urinary tract infection) and technique related. Furthermore, the risks of complications were negatively associated with the Index A. An IAP can be optimal set up in laparoscopic high ligation of hernia sac by using the Index A.

Surgical site infection after open and laparoscopic surgery in children: a systematic review and meta-analysis.

Surgical site infections (SSIs) are the most common healthcare-associated infections in patients undergoing surgery. Various randomised control trials (RCTs) indicate that laparoscopic procedures can be associated with better outcomes compared to open procedures. However, how open versus laparoscopic approaches compare across various paediatric procedures with respect to SSI rate remains poorly defined. In this review, we examined RCTs that directly compare SSI rates after open versus laparoscopic operations for appendicitis, gastro-esophageal reflux, inguinal hernia, and pyloric stenosis. MEDLINE, Embase, and Web of Science were searched for RCTs comparing four types of open versus laparoscopic operations in children. The operations included appendectomy, fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy. 364 records were identified and screened, 54 full-text articles were assessed for eligibility, and 17 RCTs were included in the analysis. SSI rate was the primary outcome. Operative time and length of stay (LOS) were the secondary outcomes. A meta-analysis was conducted using RevMan 5.4 software. Laparoscopic appendectomy had a lower SSI rate than open appendectomy (odds ratio of 2.22 [1.19, 4.15] p = 0.01). Laparoscopic fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy for pyloric stenosis were not associated with lower SSI rate compared to open surgery. Operative time was shorter in open fundoplication (- 71.22 min [- 89.79,  - 52.65] p < 0.00001) than laparoscopic fundoplication. There was no significant difference in operative time of any of the other procedures. There was no significant difference in LOS between open and laparoscopic procedures for all types of operations analysed. Based on the findings of this review, it is recommended to utilise the laparoscopic approach over the open approach to reduce SSI risk in paediatric appendectomy.

Application of accelerated rehabilitation surgery in laparoscopic surgical nursing of children with biliary atresia

Objective To explore the nursing effect of enhanced recovery after surgery (ERAS) in laparoscopic surgery for children with biliary atresia. Methods From May 2016 to May 2017, 80 children with biliary atresia admitted to the hospital for laparoscopic surgery were randomly divided into the control group and the experimental group, 40 cases each.Conventional nursing was used in the control group and ERAS nursing was used in the experimental group.Postoperative feeding, anal defecation time and complications were compared between the two groups. Results There were statistically significant differences in postoperative feeding time, anal defecation time, hospital stay and cost between the two groups(P 0.05). Conclusions The nursing effect of ERAS on children with laparoscopic biliary atresia is good, which significantly shortens the postoperative hospitalization time, reduces the hospitalization cost, and accelerates the recovery of the children. Key words: Biliary atresia; Accelerated rehabilitation surgery; Nursing

Comparison of the effects of two anesthetic methods on laparoscopic surgery in children

Objective To compare the effects of two anesthetic schemes on pediatric laparoscopic surgery, and the influence on stress response and hemodynamics. Methods From November 2016 to November 2017, 100 children underwent laparoscopic surgery in the Affiliated Hospital of Medical College of Ningbo University were selected and divided into two groups by odd even number of beds, with 50 cases in each group.The control group was treated with general anesthesia.The observation group received total intravenous anesthesia with remifentanil and propofol.The anesthesia effect, stress response and hemodynamic indexes were compared between the two groups. Results The postoperative waking time[(31.48 ±4.19)min], the time of disappearance of mascara reflex[(2.32±1.62)min], the recovery time of spontaneous respiration [(1.96±1.45)min], the incidence of adverse reactions[4.00%(2/50)], Ramsay score[(3.69±0.43)points], VAS score[(1.96±1.42)points], immediate Ramsay score[(2.11±0.82)points] and immediate VAS score[(2.31±0.43)points] in the observation group were better than those in the control group (t=15.623, 1.436, 5.436, χ2=5.432, t=1.187, 1.528, 2.136, 2.431, all P<0.05). At different time points, the MAP, HR and stress response(cortisol, blood glucose, PaO2, MAP) in the observation group were better than those in the control group(all P<0.05). Conclusion General anesthesia has higher risk in children undergoing laparoscopic surgery and can prolong the time of conscious consciousness.Remifentanil combined with propofol, total intravenous anesthesia can stabilize hemodynamics, improve the safety of anesthesia and alleviate stress reaction in children undergoing laparoscopic surgery. Key words: Anesthesis, general; Anesthesis, intravenous; Laparoscopes; Stress response; Hemodynamics; Efficacy; Safety; Child

Experience with laparoscopic procedures in children with pancreatic pseudocysts

Introduction. Pancreatic pseudocysts are encapsulated fluid accumulations in the lesser sac, devoid of epithelial lining. Pseudocysts occur after traumatic or inflammatory injury of the pancreatic parenchyma and are relatively rare in children. In recent years, there has been a trend towards minimally invasive surgery for pancreatic pseudocyst. The article presents the experience of laparoscopic operations. Purpose to the study  is to evaluate the effectiveness of laparoscopic operations in children with pancreatic pseudocysts. Materials and methods. There were 11 patients, range 4–17 years, from 2013 to 2018. An indication for surgery was the presence of a cystic cavity with a formed wall, more than 6 cm in size, which was not amenable to conservative management. In cases of infection of unformed pseudocyst, we conducted external drainage through the anterior abdominal wall and the gastrocolic ligament. Results. Surgical therapies for 11 patients consisted external drainage (2), laparoscopic Roux-en-Y cystojejunostomy (6), laparoscopic partial cystectomy with distal pancreaticojejunostomy (1), laparoscopic partial cystectomy with longitudinal pancreaticojejunostomy (2). We don’t have intraoperative complications. Early postoperative complications occurred in 2 patients: external pancreatic fistula in the place of drainage, which closed independently, and intestinal obstruction at the level of the Roux-en-Y anastomosis, which required reconstructive surgery. Conclusion . The type of intervention should be determined by the etiology of the cyst, localization and connection with the main pancreatic duct. Laparoscopic surgery in children with pancreatic pseudocysts is effective and less traumatic. Laparoscopy allows to conduct a full revision, to take material for histological examination, to perform, if necessary, sequestrectomy, to ensure reliable long-term drainage.

Effects of Carbon Dioxide Insufflation and Trendelenburg Position on Brain Oxygenation During Laparoscopy in Children.

Laparoscopic appendectomy has become more popular compared with the open appendectomy in children, but there are limited data on the effects of pneumoperitoneum and Trendelenburg position on cerebral oxygenation. This study was designed to evaluate the changes in cerebral saturation using near-infrared spectroscope during laparoscopic surgery in children. The children underwent laparoscopic (LAP Group, n=22) or open appendectomy (OPEN Group, n=22). Right and left cerebral oxygenation (RScO2-LScO2), heart rate (HR), mean arterial pressure (MAP), end-tidal CO2pressure (PETCO2), and peripheral oxygen saturations (SpO2) were recorded between anesthesia induction (T0, baseline), after induction (T1), after intubation (T2), 5 minutes after intubation (T3), 5 minutes after pneumoperitoneum-15th minute at OPEN (T4), 5 minutes after Trendelenburg-20th minute at OPEN (T5), 30 minutes after pneumoperitoneum-45th minute at OPEN (T6), 5 minutes after supine position-skin suturing at OPEN (T7), 5 minutes postextubation (T8). Groups were similar with respect to their demographic data. In LAP group, a significant increase in HR was recorded at T5. No significant difference was observed in the MAP, PETCO2, SpO2, RScO2, and LScO2 values between the groups. There was a significant increase in the perioperative T1 to T8 values compared with the T0 values in LScO2 of the LAP group. Our results suggest that pneumoperitoneum and Trendelenburg position does not alter the hemodynamic values and can be safely performed in children without altering regional brain oxygenation levels.

Laparoscopic Surgeries in Pediatric Abdominal Surgical Emergencies

The article presents a literature review of pediatric abdominal surgical emergencies in the Russian Federation. The article considers the issues of the development of laparoscopic surgery in pediatrics, the current state of this problem in surgical hospitals, the difficulties associated with transition to minimally invasive surgical interventions, in providing emergency surgical care for children. The possible risks of laparoscopic access and methods for their reduction were analyzed. The advantages of this technique were specified in comparison with open surgical interventions. The reliable economic efficiency of the offered technique was demonstrated. The analysis of the literature sources showed that there was no consensus on laparoscopic treatment for complicated abdominal diseases after previous open repair; and there were also no clear algorithms in clinical practice for complete transition to laparoscopic surgery in children. The analysis revealed very few economic studies on the efficacy of laparoscopic interventions.

Laparoscopic surgery in children with congenital heart disease

Laparoscopic surgery in children with congenital heart disease

Mortality and Morbidity after Laparoscopic Surgery in Children with and without Congenital Heart Disease

To determine the risk of morbidity and mortality after laparoscopic surgery among children with congenital heart disease (CHD). Cohort study using the 2013-2014 National Surgical Quality Improvement Program-Pediatrics, which prospectively collected data at 56 and 64 hospitals in 2013 and 2014, respectively. Primary exposure was CHD. Primary outcome was overall in-hospital postoperative mortality. Secondary outcomes included 30-day mortality and 30-day morbidity (any nondeath adverse event). Among 34?543 children who underwent laparoscopic surgery, 1349, 1106, and 266 had minor, major, and severe CHD, respectively. After propensity score matching within each stratum of CHD severity, morbidity and mortality were compared between children with and without CHD. Children with severe CHD had higher overall mortality and 30-day morbidity (OR 12.31, 95% CI 1.59-95.01; OR 2.51, 95% CI 1.57-4.01, respectively), compared with matched controls. Overall mortality and 30-day morbidity were also higher among children with major CHD compared with children without CHD (OR 3.46, 95% CI 1.49-8.06; OR 2.07, 95% CI 1.65-2.61, respectively). Children with minor CHD had similar mortality outcomes, but had higher 30-day morbidity compared with children without CHD (OR 1.71, 95% CI 1.37-2.13). Children with major or severe CHD have higher morbidity and mortality after laparoscopic surgery. Clinicians should consider the increased risks of laparoscopic surgery for these children during medical decision making.

[Efficacy evaluation of laparoscopic surgery for children with persistent cloaca].

To explore the feasibility and efficacy of laparoscopic surgery in the treatment of children with persistent cloaca. Clinical data of 26 female children with high type persistent cloaca undergoing operation in the Capital Pediatric Institution between November 2005 and February 2015 were retrospectively analyzed. Mean age of these children was (1.4±1.6) years old. Distal end of rectum locating in the superior border of pubis was the standard of diagnosis. Laparoscopy-assisted anorectoplasty (LAARP), vaginoplasty and urethroplasty were performed in 17 cases (LAARP group), including 3-port laparoscopy in 12 cases and single-port laparoscopy in 5 cases. Abdominoperineal pull through (APPT), vaginoplasty and urethroplasty were performed in the other 9 cases (APPT group). Sacral ratio (SR), length of common channel, intraoperative blood loss, operation time, postoperative hospital stay, postoperative complications and bowel function were compared between two groups. Postoperative defecation was evaluated by the Krickenbeck standard. Operations were successfully performed in all patients and no case in LAARP group was transferred to open abdominal operation. There were no significant differences in SR value, length of common channel and age at operation between the two groups. As compared to APPT group, the mean operative time was shorter [(124.1±4.9) minutes vs. (131.8±3.2) minutes, P=0.000], the intraoperative blood loss was less [(10.5±2.1) ml vs. (16.2±2.7) ml, P=0.000], and the postoperative hospital stay was shorter [(5.7±0.5) days vs. (9.2±0.4) days, P=0.000] in LAARP group. In LAARP group, there were no significant differences in operation time, intraoperative blood loss and postoperative hospital stay between 3-port and single-port laparoscopic surgery (all P>0.05). The mean follow-up period was (4.0±2.8) months in LAARP group and (6.0±2.3) months of APPT group. There is one case have wound infection in ARRT patients. The rates of voluntary bowel movement, soiling, constipation (grade 1, 2, 3) were similar in both groups, however, the overall bowel function after LAARP was better than that of ARRT according to the Krickenbeck classification (10.7±0.2 vs. 9.7±1.2, P=0.047). Postoperative rectal mucosa prolapse was found in 2 cases of LAARP group and 1 case in APPT group. One case of APPT group developed wound infection. No urethrovaginal fistula relapse, anal stenosis or urethral stricture was found in all the cases. The LAARP is safe and feasible in the treatment of persistent cloaca.

Laparoscopy in pediatric surgery: Implementation in Canada and supporting evidence

Background/purposeThe purpose of this study was to assess the diffusion of laparoscopy usage in Canadian pediatric centers and the relationship between uptake of laparoscopic surgery and the level of evidence supporting its use. MethodsNational data on four pediatric laparoscopic operations (appendectomy, pyloromyotomy, cholecystectomy, splenectomy) were analyzed using the Canadian Institute for Health Information Discharge Database (2002–2013). The highest level of evidence to support the use of each procedure was identified from Cochrane, Embase, and Pubmed databases. Chi-square test for trend was used to determine significance and time to plateau. ResultsThere were 28,843 operations (open: 12,048; laparoscopic: 16,795). Use of laparoscopic procedures increased over time (p<0.0001). A plateau was reached for cholecystectomy (2006), splenectomy (2007), and appendectomy (2012), but not for pyloromyotomy. Laparoscopic pyloromyotomy in 2013 remains less diffused than the other procedures (p<0.0001). Laparoscopic appendectomy and pyloromyotomy are supported by level-1a evidence in children, whereas cholecystectomy and splenectomy are supported by level-1a evidence in adults but level-3 in children. ConclusionsIn Canada, it has taken a long time to reach high-level implementation of laparoscopic surgery in children. Laparoscopic cholecystectomy first reached plateau, whereas laparoscopic pyloromyotomy continues to increase but remains low despite high level of evidence in support of its usage compared to open surgery.