Laparoscopic Bowel Injuries in Children

Abstract

Background

: Bowel injury is a potential complication of any abdominal or retroperitoneal surgical procedure. We reviewed our series to determine how to identify and prevent such injuries.

Patients and Methods

: During a 10-year period, 3090 laparoscopic procedures were performed, and 15 perforations of a hollow viscus were recorded (0.5%). Perforation was caused by monopolar electrocautery in five patients, crushing by 3-mm forceps in four, and sharp dissection in six. The site of the perforation was the small bowel in six patients, the colon in three, the stomach or duodenum in two patients each, and the esophagus or pylorus in one patient each.

Results

: There were no perforations related to trocar insertion because we used an open technique. All perforations occurred during advanced procedures. Injuries were recognized at the time of surgery in 12 patients and repaired immediately by laparoscopy (N = 6) or laparotomy (N = 6). The follow-up was uneventful in these patients. Three times, the injury was recognized 4 to 8 days postoperatively because of symptoms of peritonitis (ileus, pain, fever). Two patients were reoperated on by laparotomy and one by laparoscopy. Recovery was achieved with a prolonged hospital stay.

Conclusions

: Young age (six patients were <6 months old) is correlated with a small working space, fragility of tissues, and use of 3-mm instruments and seems to favor bowel injury. The risk did not correlate with the experience of the surgeon. Diagnosis can be difficult in the postoperative period. We recommend special care when using instruments, particularly in manipulating dilated or ischemic bowel of neonatal and other infants. Use of a monopolar hook in a small space should be avoided. The surgeon should always take a last look at the end of the procedure, and if there is any doubt about the presence of injury, such as when there is a superficial burn or laceration, a preventive repair should be done.