Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children

Infographic · Mar 2025 · 1 min read

In brief

Multi-center study of 1,945 stable children with penetrating abdominal trauma found laparoscopy used in only 12%, more commonly for stab wounds than gunshots. Laparoscopic patients had shorter hospital stays and fewer subsequent procedures with no increase in missed injuries, suggesting broader application may be warranted in appropriately selected stable pediatric trauma patients.

Laparoscopy is underutilized in stable pediatric penetrating abdominal trauma, used in only 12% of cases despite favorable outcomes.
LAP is more commonly employed for stab wounds (24%) than gunshot wounds (7%) and more frequently at dedicated pediatric trauma centers.
Laparoscopic approach showed lower rates of subsequent procedures (2% vs 11% open) with no increase in missed injuries or mortality.
Stable patients were defined as those without severe extra-abdominal injury (AIS≥3), altered mental status (GCS<13), or shock (elevated SIPA).
Standardized criteria are needed to identify which stable pediatric penetrating trauma patients would benefit most from laparoscopic exploration.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with icons representing different surgical procedures. Each column contains statistical data presented with percentage figures and bullet points. Color-coded sections distinguish between efficacy metrics (green tones) and complication rates (amber/red tones). Simple anatomical illustrations accompany each surgical technique.

Utsav M. Patwardhan, Casey R. Erwin, Alexandra S. Rooney, Bryan Campbell, Benjamin Keller, Andrea Krzyzaniak, Vishal Bansal, Michael J. Sise, Michael J. Krzyzaniak, Romeo C. Ignacio, Jr.

Introduction: In stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients.

Methods: The American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (<18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission. Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) < 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries.

Results: Among 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < .01). There was higher use of LAP at pediatric centers (p < .01). Although there was no difference in mortality or complications by operative type, open patients were more severely injured, had a longer LOS (p < .01), and had more subsequent procedures (11% of open, 2 % LAP, 7% LCO, p < .01).

Conclusion: In stable children with penetrating abdominal trauma, LAP is most often utilized after stabbing and at pediatric trauma centers, but its overall use remains uncommon. LAP patients had lower rates of subsequent procedures and no increase in unexpected operations suggesting low rates of missed injuries. Criteria are needed to identify stable patients presenting after penetrating trauma who can benefit from a LAP approach.

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