Role of Laparoscopy in Pediatric Adhesive Intestinal Obstruction: Our Experience in a Tertiary Care Center

Abstract

Introduction: Postoperative adhesive intestinal obstruction is a common sequela of laparotomy, with an incidence of 1-5%, higher in neonatal cases (6-8%). Conservative management is preferred, but 35-45% of cases require surgery. While laparoscopic adhesiolysis is well-documented in adults, pediatric data is scarce. This study assesses the feasibility of laparoscopic adhesiolysis in pediatric adhesive obstruction cases.Materials and Methods: This retrospective study over one year included children with adhesive intestinal obstruction. Data collected: demographics, conservative management details, surgery type and findings, conversion to open surgery, postoperative course, and recurrence. Mean values were recorded.Results:Twelve patients (7 boys, 5 girls) were studied. Initial conservative management was attempted for 48 hours. Surgeries included stoma closure (33%), appendectomy (50%), trauma surgery (8%), and perforation repair (8%). Three patients required laparoscopic adhesiolysis. No conversions to open surgery occurred. Mean operative time was 56.2 minutes. Patients resumed oral intake within 24 hours and were discharged within 48 hours. Mean hospital stay was 42.5 hours. No complications were noted.Discussion: Laparoscopic adhesiolysis, established as safe in adults, is also feasible in pediatric patients, offering reduced morbidity and faster recovery. Placement of the first port requires caution due to potential adhesions. Experienced surgeons achieve better outcomes. Diagnostic laparoscopy is superior to laparotomy for identifying obstruction causes.Conclusion: Laparoscopic adhesiolysis is safe and effective in pediatric patients, with minimal morbidity and early recovery. Mean operative time was 56.2 minutes, with rapid recovery evidenced by early oral intake and short hospital stay (mean 42.5 hours).Conclusion: Laparoscopic adhesiolysis is safe and effective in pediatric patients, offering minimal morbidity and facilitating early recovery.