Aim: Departmental survey of the pediatriclaparoscopic and endoscopic procedures in Jinnah hospital Lahore.Methodology: It isa retrospective study was based on 2.5 years of surgical experiences.
Multipleminimally invasive procedures with laparoscopic conversions were analyzed amongupcoming patients. Results: Surveybased on minimally invasive surgeries over approximately 2.5 years wasconducted with 107 patients (69 male: 38 female) out of which 57% surgerieswere laparoscopic and its conversions and 43% were with other proceduresinclude Bronchoscopy, Sigmoidoscopy, Gastroscopy, Colonoscopy, Cystoscopy, withwhich “diagnostic laparoscopy” for impalpable UDT and acute abdomen and “diagnosticcystoscopy” among patients with urethral stricutures were widely used.
Postoperative complications commonly include pain and fever. Conclusion: Minimallyinvasive pediatric surgical techniques are increasingly adapted as moreadvanced procedures with a lower complication rate. It has a number ofadvantages, includes less pain, early discharge to home and no scars as welland the rate is increased by 28% at the end of this study. INTRODUCTIONEthically harmless medical care at priority hasbeen a lifelong influence in patient’s treatment with least invasiveadministration methodology thus, the minimally invasive surgery has immenselyadapted by paediatric and other surgeons (Nwokoma & Tsang, 2011). Surgery is usually invasive and some incisionsseems like open surgery. These incisions may leave big painful wounds and minimallyinvasive surgery allowed surgical techniques to limit the incisions size neededwith quick healing by limiting pain and associated infection risk (Sethi et al.2013).
A number of medical procedures end up withthe suffix “oscopy” such as endoscopy, laparoscopy, etc. are branched from minimallyinvasion (Ahmed 2009).To examine interior of a holloworgan or a body cavity, endoscopy procedure is carried forward which varies onthe type of body cavity and itself as well i.e. bronchoscopy, sigmoidoscopy, gastroscopy,colonoscopy, cystoscopy, laparoscopy etc. Laparoscopy, as a minimally invasive protocol,is a concern with the visual inspection of peritoneal cavity with telescope bythe pneumoperitoneum creation (Cortesi et al.
, 1976). Laparoscopy concernedwith abdominal or pelvic cavity surgeries regarding diagnosis or therapeutic evaluation(Lee, 2009). Popularity of laparoscopic surgical treatmentapproach has been increased since early 20th century and explorationof advantages in regarding area are better explain in adults instead ofpaediatric surgery because of lack of conditions in the paediatric age groupand are commonly present in adults tounderstand the advancement in the application of laparoscopic surgery (Nwokoma& Tsang, 2011). METHODOLOGYRetrospective study was conducted from April 15 toNovember 17.
Multiple minimally invasive procedures include endoscopicprocedures and laparoscopic conversions that were analyzed among upcomingpatients.RESULTSThe number of Laparoscopic and endoscopic procedures thathad been performed over past 2.5 years is 107, out of which 59 werelaparoscopies (55%), and 48 (45%) were other procedures including 1bronchoscopy (1%), 3 sigmoidoscopies (2.
8%), 6 Gastroscopies (5.6%), 10colonoscopies (9.6%), and 28 cystoscopies (26%).
The majority of surgeries werediagnostic laparoscopies for impalpable UDT and acute abdomen (35.5% of allminimally invasive surgeries), 10 were colonoscopies for per rectal bleeding(9.6%) followed by diagnostic cystoscopies (22.4%) in the patients withuretheral stricutures (7.
6%) and for the determination of location ofconfluence in patients with urogenital sinuses (8.5%). The other procedures include Laparoscopicappendicectomies, laparoscopic cholecystectomies, laparoscopic nephrectomy, needleassisted herniotomies, laparoscopic abscess drainage.
Out of 59 laparoscopies 6were converted to open (10.3%). Our complications are postoperative fever, andpain. DISCUSSIONThere isbig difference among open and laparoscopic surgery skillfulness and isnecessary to evolve in this field with new advancements (Aggarwal, 2004). Plentifulcase successions have been addressed concerned area (Chen, 1996). In a study 734 minimally invasive procedures had beenperformed within 9 years by which majority protocols were appendicectomy, orchiopexyand diagnostic laparoscopy with complications of postoperative fever, bleeding,bile leak, cyst excision etc. and their conversions were 5% over 1999 to 2001.(Saravanan, et al.
, 2008)The evaluation and treatment for cancer at 15participating centers 88 minimally invasive surgical procedures among 85children was conducted. Laparoscopy and thoracoscopic operations majorlyconducted. Holcomb, et al., (1995) found laparoscopy as the most accurate procedurewith minimal side effects and thoracoscopy nearly efficient with to some extenthigher morbidity. Currently 107 surgeries undergo with minimally invasiveprocedures. Laparoscopic conversions and endoscopy with the variationevaluations were performed. Majority of the surgeries were diagnosticlaparoscopy as a Laparoscopic conversion and diagnostic cystoscopy in terms ofendoscopic procedure and pain and fever were recorded as postoperativecomplications that are commonly observed in patients.
CONCLUSION Minimally invasive procedures areincreasingly being adapted all over the world particularly among pediatricsurgeons because of its advantages like less pain, short hospital stay and lessmorbidity. Therefore it is need of time to provide laparoscopic training topediatric surgeons in our country. We have taken initiative at our institutewith a hope that with the passage of time in collaboration and supervision oftrained personal and advanced facilities our skills and results will improve.
ACKNOWLEDGEMENT The authors would like to express their appreciation totheir colleagues who have worked with them in various studies evaluating theclinical application of laparoscopy in children; some of the publicationsincluded in the text.