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A Comparative Study of Laparoscopic versus Open Management of Index Small Bowel Obstruction in Children.
Patwardhan, Utsav M; Floan, Gretchen M; Calvo, Richard Y; Acker, Shannon N; Choi, Pamela M; Prieto, James M; Bansal, Vishal; Sise, Michael J; Thangarajah, Hari; Fairbanks, Timothy J; Lazar, David A; Ignacio, Romeo C.
Afiliação
  • Patwardhan UM; Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA.
  • Floan GM; Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA.
  • Calvo RY; Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA.
  • Acker SN; Colorado Children's Hospital, 13123 E 16th Ave, Aurora, CO 80045, USA.
  • Choi PM; Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA.
  • Prieto JM; Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA.
  • Bansal V; Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA.
  • Sise MJ; Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA.
  • Thangarajah H; Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA.
  • Fairbanks TJ; Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA.
  • Lazar DA; Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA.
  • Ignacio RC; Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA. Electronic address: r1ignacio@health.ucsd.edu.
J Pediatr Surg ; 59(3): 416-420, 2024 Mar.
Article em En | MEDLINE | ID: mdl-37978001
INTRODUCTION: There is limited literature on the optimal approach to treat adhesive small bowel obstruction (ASBO) in children. We sought to compare rates and outcomes of laparoscopic (LAP) and open (OPEN) surgery for pediatric ASBO. METHODS: A California statewide database was used to identify children (<18 years old) with an index ASBO from 2007 to 2020. The primary outcome was the type of operative management: LAP or OPEN. Secondary outcomes were hospital characteristics, patient demographics, and postoperative complications. We excluded patients treated non-operatively. RESULTS: Our study group had 545 patients. 381 (70%) underwent OPEN and 164 (30%) LAP during the index admission. Over the study period, there was increasing use of laparoscopic surgery, with higher use in older children (p < 0.001). LAP was associated with fewer overall complications (65.2% vs. 81.6%, p < 0.001), with a decreasing trend in complications over time (p < 0.001). The LAP group had significantly lower rates of bowel resection (4.9% vs. 17.1%, p < 0.001), length of stay (LOS) (17 vs. 23 days, p < 0.001), and TPN use (12.2% vs. 29.1%, p < 0.001). Mortality rates were equivalent. Although the LAP group had lower readmission rates (22.6% vs. 37.3%, p < 0.001), the length of time between discharge and readmission was similar (171 vs. 165 days, p = 0.190). DISCUSSION: The use of laparoscopic surgery for index ASBO increased over the study period. However, it was less commonly utilized in younger children. LAP had fewer overall complications as well as shorter LOS, decreased TPN use, and fewer readmissions. The benefits and risks of each approach must be weighed. LEVEL OF EVIDENCE: III.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Procedimentos Cirúrgicos do Sistema Digestório / Laparoscopia / Obstrução Intestinal Limite: Adolescent / Child / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Procedimentos Cirúrgicos do Sistema Digestório / Laparoscopia / Obstrução Intestinal Limite: Adolescent / Child / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article