Therapeutic laparoscopy for pediatric abdominal trauma

Abstract Background For the surgical treatment of traumatic hollow viscus injuries, laparoscopy offers a potentially less morbid approach to open exploration among appropriately selected patients. This study aimed to evaluate utilization trends and efficacy of laparoscopy in the management of pediatric abdominal trauma. Study design To gain both study granularity and power, our institutional trauma registry (2005–2017) and the National Trauma Data Bank (NTDB; 2010–2015) identified patients ≤ 18 years who required celiotomy for abdominal trauma. Injury mechanisms, patient characteristics, and hospital courses were compared between open and laparoscopic approaches. Unadjusted and adjusted statistical analyses were performed. Results Overall, data were similar among 393 institutional and 11,399 NTDB patients undergoing laparoscopic ( n  = 88, 22%; n  = 1663, 16%) or open ( n  = 305, 78%; n  = 9736, 85%) surgery for abdominal trauma. In both registries, laparoscopy was more commonly employed in younger (institutional p  = 0.026; NTDB p p  = 0.019; p p p  = 0.031; p p  = 0.013; NTDB OR 0.69 (0.55–0.88), p  = 0.002]. An increase in utilization of MIS for pediatric abdominal trauma was detected over time (NTDB: r  = 0.88, p  = 0.02). Conclusion For the management of pediatric abdominal trauma, laparoscopy was employed typically in younger, more stable, and female patients sustaining blunt injuries. Appropriately selected patients have similar or better outcomes to patients treated with laparotomy, with no increase in adverse events or missed injuries. Increased utilization of laparoscopy to manage abdominal trauma in children suggests greater acceptance of this approach. Level of evidence Level III.