Patient Preparation

There is little specific preparation needed for children to undergo laparoscopy, although recognition of the smaller operative spaces and the occasional physiological limitations of some children are important.

Children to undergo any possible pelvic surgery laparoscopically, including orchiopexy, antireflux surgery or vesical procedures, should have a limited bowel preparation aimed at debulking the rectosigmoid. This can be efficiently performed using a liquid diet the day before and a bisacodyl suppository or oral tablet the night before the procedure.

While laparoscopy is well tolerated by most children and infants, there is the potential for respiratory compromise due to the elevated intra-abdominal pressures.

Children with limited respiratory reserve such as former premature infants with a history of bronchopulmonary dysplasia, those with restrictive thoracic conditions, and very young infants may show sensitivity to the pneumoperitoneum. They have a very limited ability to maintain adequate oxygenation when intra-abdominal pressure is increased and may show desaturation with increased pressures. These risks may be anticipated and often are adequately controlled by limiting pneumoperi-toneum pressures, but if there is concern, preoperative evaluation should be obtained to assess the degree of limitation. Similarly, in children with congenital cardiac anomalies, preoperative evaluation is useful, although we have rarely seen any clinically apparent compromise.

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