title: The Role of Laparoscopy in the Acute Neonatal Abdomen.
abstract: IntroductionThe surgical treatment of the acute neonatal abdomen still poses a challenge in pediatric surgery. Various underlying etiologies require different surgical procedures. Until today the role of laparoscopy in the surgical treatment of the acute neonatal abdomen is controversial. The aim of this study was to analyze our experiences with laparoscopy and to perform a review of the literature. Methods Retrospective, single-institution study including all term and preterm neonates initially undergoing laparoscopy due to an acute abdomen. Results Altogether, 17 neonates presenting with an acute neonatal abdomen initially underwent laparoscopy. Unnecessary laparotomy could be avoided in 9 of 17 (53%) neonates. After diagnostic laparoscopy, 2 patients did not require any further surgical intervention. Eight neonates presented midgut atresia intraoperatively, 5 of them underwent laparoscopic-assisted correction. Successful laparoscopic derotation of an acute volvulus (n = 1) and laparoscopic appendectomy (n = 1) could be performed. Conversion to open surgery was necessary in 8 neonates (47%) due to creation of a stoma (n = 5), multiple intestinal bands causing poor visualization (n = 2), and bowel necrosis (n = 1). Conclusions Laparoscopy is a useful diagnostic tool to evaluate the need for further surgical intervention in the acute neonatal abdomen and enables immediate surgical treatment of acute volvulus, appendicitis, or intestinal atresia. In case of conversion to laparotomy, precise localization of the incision is guaranteed. Minimization of the surgical trauma and avoidance of unnecessary laparotomy are the most important benefits of the minimal-invasive approach for the critically ill neonate.
authors.affiliation: University Medical Center Ulm, Ulm, Germany burgmeierchr@yahoo.de.
authors.forename: Christine
authors.initials: C
authors.lastname: Burgmeier
authors.affiliation: University Medical Center Mainz, Mainz, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Schier
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D061887:Conversion to Open Surgery / Q000379:methods*; D016638:Critical Illness; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D047929:Term Birth
keywords: acute abdomen; laparoscopy; neonate; preterm; term