Minimally invasive surgery in children with a history of congenital abdominal wall defects.
OBJECTIVE
Children with a history of a congenital abdominal wall defect (AWD) occasionally require additional abdominal surgery later in life, after their defect is closed. In an effort to evaluate surgical history and assess the feasibility of laparoscopic surgery in this select patient population, a retrospective review was conducted looking at all patients treated with congenital AWD at a tertiary-care facility.


METHODS
Patients admitted between January 1, 2000 and January 1, 2011 with AWD were included in the study. Abdominal surgical procedures subsequent to closure of the defect were compared for indication, technique, length of surgery, estimated blood loss, and postoperative length of stay.


RESULTS
During the stated time period, there were 139 admissions with AWD (67 girls and 72 boys). Thirty percent of the children (n=43) underwent subsequent abdominal surgery after the closure of their defect for a total of 65 procedures. Seventy-four percent of these procedures (n=48) were performed by an open technique, and 26% were laparoscopic (n=17). Because of dense adhesive disease, 2 cases (12%) were converted from laparoscopic to open. There were no complications as a result of laparoscopic surgery in any of the patients.


CONCLUSIONS
This study evaluates the surgical history of patients with AWDs after their defect is closed. The results of this study suggest that in many situations, laparoscopic surgery is feasible and can be safely conducted on children with a history of congenital AWD. Based on these results, a history of congenital AWD should not be considered a contraindication for laparoscopy.
Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Sarah J
SJ
Hill
Mark L
ML
Wulkan
D034861:Abdominal Wall / Q000002:abnormalities* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male; D058502:Pentalogy of Cantrell / Q000601:surgery*; D012189:Retrospective Studies