Utsav M Patwardhan, Casey R Erwin, Alexandra S Rooney, Bryan Campbell, Benjamin Keller, Andrea Krzyzaniak, Vishal Bansal, Michael J Sise, Michael J Krzyzaniak, Romeo C Ignacio
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Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) < 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries.</p><p><strong>Results: </strong>Among 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < .01). There was higher use of LAP at pediatric centers (p < .01). 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引用次数: 0
摘要
简介：对于腹部穿透性创伤的稳定期儿童，有关腹腔镜（LAP）应用的文献仍然有限。鉴于越来越多的证据表明腹腔镜手术适用于选择性成人创伤患者，我们回顾了儿科创伤患者的当代实践和结果：方法：我们利用美国外科医生学会（ACS）创伤质量项目的数据来确定儿童患者（结果：在1945名接受腹腔镜手术的患者中，有1/3的患者接受了腹腔镜手术：在1945名因穿透性创伤接受腹部手术的患者中，32%的患者被刺伤，68%的患者为枪伤（GSW）。235名患者（12%）发生了LAP，145名患者（7.4%）发生了LCO。在研究期间，LAP 的比例没有变化。刀刺伤患者使用 LAP 的比例高于枪伤患者（分别为 24% 和 7%，P）：在病情稳定的腹部穿透性创伤患儿中，LAP最常在刺伤后和在儿科创伤中心使用，但其总体使用情况仍不常见。LAP患者的后续手术率较低，意外手术率也没有增加，这表明漏诊率较低。需要制定标准以确定穿透性创伤后病情稳定的患者是否可以从LAP方法中获益：证据等级：III。
Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children.
Introduction: In stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients.
Methods: The American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (<18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission. Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) < 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries.
Results: Among 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < .01). There was higher use of LAP at pediatric centers (p < .01). Although there was no difference in mortality or complications by operative type, open patients were more severely injured, had a longer LOS (p < .01), and had more subsequent procedures (11% of open, 2 % LAP, 7% LCO, p < .01).
Conclusion: In stable children with penetrating abdominal trauma, LAP is most often utilized after stabbing and at pediatric trauma centers, but its overall use remains uncommon. LAP patients had lower rates of subsequent procedures and no increase in unexpected operations suggesting low rates of missed injuries. Criteria are needed to identify stable patients presenting after penetrating trauma who can benefit from a LAP approach.
期刊介绍：
The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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