The influence of paediatric minimally invasive surgery on the hospital treatment duration

Abstract

Purpose: to explore the possibility of shortening hospitalization after high complexity paediatric surgical operations. Materials and methods: in 2014 - 2017 47 children (1 - 17 years old) were operated. Children were discharged from the hospital after medical stabilization, further treatment on an outpatient basis. Results: 41 patients (19 boys and 22 girls) with abdominal pain were operated. In 23 cases were destructive forms of acute appendicitis. Of these, 8 patients with peritonitis (4 - generalized peritonitis). Cryptogenic peritonitis simulating acute appendicitis in 6 girls, 1 girl had torsion of ovarian cysts. In 1 case (3.5 year old) was a penetrating abdominal trauma and loops of the small intestine, in 2 - recurrent intestinal invagination. Also, 2 children with hydronephrosis completed by plastic ureteropelvic junction, 4 patients with vesicoureteral reflux was performed injection plastic of the ureteral orifice and detrusor injections with botulinum toxin. In all cases underwent endoscopic surgery without conversion to open surgery. Children with «emergency» diagnosis were discharged from the hospital on the 3,5 days (1-5,5 days), planned patients on the 4 days. One patient with hydronephrosis and 1 child with generalized peritonitis have the longest hospital stays (8 and 5,5 days respectively). In case with hydronephrosis accidental removal of ureteral stent was the cause of ureteropelvic anastomosis obstruction and prolonged hospitalization. In all cases further treatment on an outpatient basis were without complications. Conclusion: laparoscopic surgery in children certainly carries many advantages. These include less pain, rapid recovery, shorter hospital stay, less wound complications and better cosmetic result. The laparoscopic technique in comparison with medical and economic standard practically reduced the hospital stay period into halve without increasing of complications. Laparoscopic surgery in infants and young children will become more widely accepted.