Postoperative Course

There is little difference in recovery patterns among children of different ages and it is difficult to determine what might predict the rapidity of recovery in particular cases. There does seem to be a tendency among children to be very quiet and sluggish in recovery for 6 to 18 hours following complex laparoscopic procedures, and then very rapidly return to their baseline level of comfort and activity. This is in contrast to the pattern seen after open surgery, which shows a steady, but usually more prolonged recovery phase. The basis for this is unclear. Most children under the age of five are ready to return home, on oral analgesics (often no more than acetaminophen), taking liquids and some solids and moving comfortably within 36 hours of the procedure, some within 24 hours. Older children usually require two or three days to achieve a similar level of comfort. Some infants have been ready for discharge on the same day following partial nephrectomy or pyeloplasty. There seems to be a general sense of malaise in the recovery period for children, although they do not usually seem to localize their pain. Even older children do not complain specifically of focal discomfort.

Rarely do children complain of shoulder pain, as is often noted in adults. A few teenagers have done so, but this is unusual. It may simply reflect the general tendency of children to be unable to localize abdominal pain.

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