title: Feasibility of emergency laparoscopic colectomy for children with acute colonic perforations and fibropurulent peritonitis.
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.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
authors.forename: Yu-Tang
authors.initials: YT
authors.lastname: Chang
authors.forename: Jui-Ying
authors.initials: JY
authors.lastname: Lee
authors.forename: Chi-Shu
authors.initials: CS
authors.lastname: Chiu
authors.forename: Jaw-Yuan
authors.initials: JY
authors.lastname: Wang
mesh_terms: D015415:Biomarkers / Q000032:analysis; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery*; D004638:Emergency Treatment; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010538:Peritonitis / Q000601:surgery*; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers