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Umbilical access in laparoscopic surgery in infants less than 3 months: A single institution retrospective review

Published:November 20, 2021DOI:https://doi.org/10.1016/j.jpedsurg.2021.11.010

      Highlights

      • Direct transumbilical access in neonatal laparoscopic surgery is cited as a risk for increased complications, including CO2 embolism.
      • Although concern for vessel injury, cannulation, and CO2 embolism exists, these complications are more likely related to the operative procedure, insufflation, and factors associated with laparoscopy, and likely not umbilical access technique.
      • Direct transumbilical access in neonatal laparoscopic surgery is cited as a risk for increased complications like CO2 embolism and vessel injury.
      • These may however be more related to the operative procedure, insufflation and laparoscopy, and less likely the umbilical access technique.

      Abstract

      Introduction

      Umbilical access in laparoscopic surgery has been cited as a factor for increased complications in low-birth-weight infants and those less than three months old. In a previous series, 10.6% of pediatric surgeons reported complications in this population associated with umbilical access, citing carbon dioxide (CO2) embolism as the most common complication. To further examine the safety of this technique, we report our outcomes with blunt transumbilical laparoscopic access at our institution over four years.

      Methods

      A retrospective review was performed of patients less than three months of age who underwent laparoscopic pyloromyotomy or inguinal hernia repair from 2016 to 2019. Operative reports, anesthesia records, and postoperative documentation were reviewed for complications related to umbilical access. Complications included bowel injury, vascular injury, umbilical vein cannulation, CO2 embolism, umbilical surgical site infection (SSI), umbilical hernia requiring repair, and death.

      Results

      Of 365 patients, 246 underwent laparoscopic pyloromyotomy, and 119 underwent laparoscopic inguinal hernia repairs. Median age at operation was 5.9 weeks [4.3,8.8], and median weight was 3.9 kg [3.4,4.6]. Nine complications (2.5%) occurred: 5 umbilical SSIs (1.4%), 1 bowel injury upon entry requiring laparoscopic repair (0.2%), 1 incisional hernia repair 22 days postoperatively (0.2%), and 2 cases of hypotension and bradycardia upon insufflation that resolved with desufflation (0.5%). There were no intraoperative mortalities or signs/symptoms of CO2 embolism.

      Conclusion

      In this series, umbilical access for laparoscopic surgery in neonates less than three months of age was safe, with minimal complications. Although concern for umbilical vessel injury, cannulation, and CO2 embolism exists, these complications are not exclusively associated with umbilical access technique.

      Keywords

      Abbreviations:

      CO2 (carbon dioxide), SSI (surgical site infection)
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