Laparoscopic and thoracoscopic surgery in infancy and childhood,the Munster/Gent experience

Laparoscopic and thoracoscopic surgery have had a tremendous impact on adult surgery, but are still rarely used in children. In the past 3 years 168 children have been treated endoscopically in the three cooperating institutions. The course of all patients was documented prospectively in order to determine the value and prove the safety of endoscopic surgery in children.

The operations performed endoscopically comprised appendectomy (n = 39), diagnostic procedures (24), adhesiolysis (n = 22), cholecystectomy (n = 13), bowel resection (n = 8), pyloromyotomy (n = 6), ovarial resection (n = 6), hiatus hernia repair (n = 22), splenectomy (n = 6), first stage of Fowler-Stephens operation for kryptorchidism (n = 3) and interruption of persistent botallic ducts (n = 6) in preterm infants.

Apart from four wound infections (2.4%) following perforated appendicitis, one of which required laparotomy for perityphlitic abscess there were no serious complications. No patient died, and overall morbidity related to the procedure was 1.8% (i.e. incidence of uneventful minor intraoperative complications). Furthermore endoscopic surgery provides a bcttcr diagnostic survey of the abdomen or thorax so that missing of secondary pathology is unlikely. Pain and reflectory impairment of bowel-function or respiration were diminished, the aesthetic results were excellent and hospitalization could be reduced to a minimum. It is concluded that laparoscopic and thoracoscopic surgery are safe and reliable procedures for children and yield very encouraging results.