Abstract
Background
Several studies have demonstrated that laparoscopic surgery is safe and effective for urgent and emergent colectomy in adulthood. The aim of the present study was to evaluate the feasibility of laparoscopic colectomy for children in emergent settings.
Methods
Between March 2008 and August 2011, 10 consecutive children with acute colonic perforations and fibropurulent peritonitis secondary to infectious colitis underwent emergency laparoscopic colectomy. Simultaneously, we reviewed and recorded the same data from another consecutive 10 patients who underwent standard laparotomy between November 2004 and February 2008. The two groups were compared with regard to operative time, length of hospital stay (LOS), and complications.
Results
The gender, age, body weight, serum C-reactive protein, number of involved bowel segments, operative time, and LOS were not significantly different (P = 0.36, 0.50, 0.33, 0.62, 0.81, 0.14 and 0.23, respectively). In the laparoscopy group, one patient required conversion to open surgery because of extensive bowel involvement, and another patient with solitary colonic perforation required reoperation for anastomostic leakage. However, patients who underwent laparotomy had a higher incidence of later complications, including wound infection, incisional hernia, and adhesion ileus (P = 0.03, 0.06, and 0.03, respectively) and thus required more additional unplanned operations (P = 0.05).
Conclusions
Emergency laparoscopic surgery is technically feasible in most children with acute colonic perforations and fibropurulent peritonitis. However, extensive intestinal involvement with multiple perforations should be an indication for converting to open surgery.
Similar content being viewed by others
References
Grams J, Tong W, Greenstein AJ et al (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891
Scheidbach H, Schneider C, Rose J et al (2004) Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1,545 patients. Dis Colon Rectum 47:1883–1888
Nash GM, Bleier J, Milsom JW et al (2010) Minimally invasive surgery is safe and effective for urgent and emergent colectomy. Colorectal Dis 12:480–484
Campos FG, Valarini R (2009) Evolution of laparoscopic colorectal surgery in Brazil. Results of 4744 patients from the national registry. Surg Laparosc Endosc Percutan Tech 19:249–254
Park HC, Lee BH (2010) Emergency laparoscopic surgery for right colonic disease with peritonitis. J Laparoendosc Adv Surg Tech A 20:541–544
Stulberg JJ, Champagne BJ, Fan Z et al (2009) Emergency laparoscopic colectomy: does it measure up to open? Am J Surg 197:296–301
Champagne B, Stulberg JJ, Fan Z et al (2009) The feasibility of laparoscopic colectomy in urgent and emergent settings. Surg Endosc 23:1791–1796
Alamili M, Gögenur I, Rosenberg J (2009) Acute complicated diverticulitis managed by laparoscopic lavage. Dis Colon Rectum 52:1345–1349
Rothenberg SS (2002) Laparoscopic segmental intestinal resection. Semin Pediatr Surg 11:211–216
Simon T, Orangio G, Ambroze W et al (2003) Laparoscopic-assisted bowel resection in pediatric/adolescent inflammatory bowel disease: laparoscopic bowel resection in children. Dis Colon Rectum 46:1325–1331
Mattioli G, Palomba L, Avanzini S et al (2009) Fast-track surgery of the colon in children. J Laparoendosc Adv Surg Tech A 19(Suppl 1):S7–S9
Chang YT, Lee JY, Liao YM et al (2008) Laparoscopic resection of a giant retroperitoneal T-shaped duplication of descending colon. J Pediatr Surg 43:401–404
Chang YT, Lin JY, Huang YS (2006) Typhoid colonic perforation in childhood: a ten- year experience. World J Surg 30:242–247. doi:10.1007/s00268-005-0148-0
Sinha R, Sharma N, Joshi M (2005) Laparoscopic repair of small bowel perforation. JSLS 9:399–402
Ramachandran CS, Agarwal S, Dip DG et al (2004) Laparoscopic surgical management of perforative peritonitis in enteric fever: a preliminary study. Surg Laparosc Endosc Percutan Tech 14:122–124
Tsai CH, Chen HL, Ni YH et al (2004) Characteristics and trends in incidence of inflammatory bowel disease in Taiwanese children. J Formos Med Assoc 103:685–691
Chang YT, Lin JY (2007) Red umbilicus as a clinical manifestation in a nineteenth-month old girl with typhoid colonic perforation. Kaohsiung J Med Sci 23:80–83
Abbas S (2007) Resection and primary anastomosis in acute complicated diverticulitis, a systematic review of the literature. Int J Colorectal Dis 22:351–357
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chang, YT., Lee, JY., Chiu, CS. et al. Feasibility of Emergency Laparoscopic Colectomy for Children with Acute Colonic Perforations and Fibropurulent Peritonitis. World J Surg 36, 1958–1962 (2012). https://doi.org/10.1007/s00268-012-1585-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-012-1585-1