title: Impact of prior surgery on the feasibility of laparoscopic surgery for children: a prospective study.
abstract: BACKGROUND
  This study aimed to determine the impact of prior surgery on the feasibility of laparoscopic surgery for children.
  
  
  METHODS
  A prospective study analyzed 471 consecutive children who underwent laparoscopic surgery over a 4-year period. Laparoscopic procedures were classified "easy," "difficult," or "demanding." The end points of the study were conversion rate, intraoperative events, and duration of operation.
  
  
  RESULTS
  A total of 89 patients (19%) had undergone previous abdominal surgery. The conversion rate was 18% for the patients with prior surgery versus 9% for those without a prior operation (16/89 vs 35/382; p < 0.05). This difference reflects a significantly higher conversion rate for "easy" procedures among patients with than among those without prior surgery, but not for "difficult" and "demanding" procedures. The type of prior surgery had no significant impact on the mean duration of the operation. Of 71 procedures, 12 (17%) after prior conventional surgery were converted, as compared with 4 (22%) of 18 after prior laparoscopy (p > 0.05). Intraoperative events, mainly attributable to adhesions and lack of overview, occurred in 8% of patients with prior procedures, as compared with 2% without former surgery (7/89 vs 9/382; p < 0.05). Relevant complications were not significantly more frequent after prior surgery. The incidence of conversions decreased with increased time between current and previous surgery. It was 64% for surgeries less than 1 year later, 25% for surgeries 1 to 5 years later, and 5% for surgeries more than 5 years later (7/11 vs 6/24 vs 3/54; p < 0.001).
  
  
  CONCLUSIONS
  Prior surgery has a limited impact on the feasibility of laparoscopic surgery for children. The conversion rate and the incidence of intraoperative events, mainly because of adhesions and lack of overviewing, is increased, but not the incidence of relevant complications. The feasibility improves considerably with increased time between surgery and prior surgery. The authors consider laparoscopy to be the first-choice technique after prior surgery.
authors.affiliation: Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Niedersachsen, Germany. metzelm@web.de
authors.forename: M L
authors.initials: ML
authors.lastname: Metzelder
authors.forename: N
authors.initials: N
authors.lastname: Jesch
authors.forename: A
authors.initials: A
authors.lastname: Dick
authors.forename: J
authors.initials: J
authors.lastname: Kuebler
authors.forename: C
authors.initials: C
authors.lastname: Petersen
authors.forename: B M
authors.initials: BM
authors.lastname: Ure
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery*; D002648:Child; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D011446:Prospective Studies; D012086:Reoperation; D000267:Tissue Adhesions