Surgical Complications

Complications in children are the same as in adults, although their clinical presentation may be less distinct and a higher index of suspicion should be established.

The potential for major complications exists due to the smaller size of the surgical field and less sturdy tissues, although the higher visibility in general should limit this risk. Early in the development of pediatric urologic laparoscopy, a survey reported an incidence of 2% with the need for surgical intervention in 0.4%. In a large review of pediatric laparoscopic complications, with the majority including diagnostic procedures, a complication rate of 2.7% was reported, with no mortality. Conversions were required in one-third of these. The most significant complications were bleeding, while others included bladder perforation during orchiopexy (Esposito, 2003 p. 310). The major risks of acute injury are obvious and rarely missed, including bleeding and injury to adjacent structures.

Occult injury to the bowel is a recognized possibility and as with adults, it seems that the clinical presentation is subtler than in bowel injury with open procedures (33). Reported cases suggest that there is less of a febrile response, more subtle clinical signs of peritonitis and a lower leukocytosis. The reasons for this remain unclear, but some authors have focused on altered immune responses following laparoscopy (34). Use of C-reactive protein as an indicator of bowel injury after laparoscopy has been reported in adults (35). None of these issues have been studied in children,

When dealing with children, following any surgical procedure, it is important to recognize their ability to maintain a well-compensated state for long periods but then to rapidly decline in their ability to remain compensated.

They will deteriorate rapidly after appearing to be stable and healthy. Early, subtle signs of that compensation should be recognized in the appropriate context, including persistent tachycardia, increased respiratory rate, and poor feeding. Of course, these patterns may simply represent postoperative effects that will resolve, but one must be cognizant of the potential for subsequent rapid deterioration. In the situation of a difficult procedure that may not have progressed as well a usual, it may be prudent to delay discharge if the child is not making a rapid recovery, just to be able to identify warning signs of either peritonitis or hemorrhage. While routine blood tests are seldom performed, these might be the situations to consider doing so.

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