Analysis for Laparoscopy Postoperative Rehabilitation Especially In Children

 

History of Laparoscopic Surgery

Laparoscopy or laparoscopy introduces in the 1940s. Gynecological surgeon, after having created a pneumoperitoneum, introduced a rigid and illuminating optic into the peritoneal cavity to look for a pelvic pathology. Laparoscopy then uses for diagnostic purposes only. If since that date, and especially from the mid-1970s, laparoscopy has imposed itself in gynecology as a therapeutic tool, in visceral and digestive surgery it is only from the mid-1980s that the technique is developed.

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In 1983 performs the first appendectomy. In 1987, performs the first laparoscopic cholecystectomy. In 1990, publishes the first series of laparoscopic cholecystectomies (36 cases). A new surgical space, on the initiative surgeons, opened up to digestive and visceral surgery, a space that has since continued to expand in this specialty.

Exponential Growth Laparoscopic Surgery

For 20 years, the growth has been international and exponential with currently many congresses, the existence of specialized learned societies such as the Society of Laparoscopic Surgery (SFCL) and companies or industrial divisions developing technologies (image systems, instrumentation) specific to laparoscopy. The majority of visceral and digestive surgeries perform laparoscopically except for organ transplants.

Statistical Study Analysis for Laparoscopy of Postoperative Rehabilitation

Many randomized controlled trials have concluded that laparoscopy is superior to conventional laparotomy in terms of postoperative rehabilitation. Laparoscopy improves the quality of post-operative follow-up as evidenced by a recent review of the literature  which includes 44 randomized controlled trials on 5292 patients operated on for appendicitis and finds a benefit in terms of postoperative pain, resumption of food, length of hospitalization and early return to activities. Another Cochrane review published in 2010 finds similar results with also a decrease in postoperative infections.

Adaptation of Laparoscopic Surgery

In addition, the interest was contagious and demographic study found that the number of laparoscopic appendectomies rose from 19% in 1997 to 38% in 2003. The indications then multiplied, first concerning simple surgeries such as appendectomy, cholecystectomy, exploration of ill-defined abdominal pain and the search for unpalliated testicles.

Advantages of Use of Laparoscopy in Children

Pediatric surgeons have been slower to adopt laparoscopy, in part because the patients are smaller, the incisions narrower, and the indications for surgery comparatively rarer than in adults. However, in the 90s, some pioneers began to perform simple laparoscopic procedures and thus proved that children could also benefit from the technique.

Then the enthusiasm and experience of some teams enabled them to learn how it performs complex procedures such as gastro-esophageal reflux cures, splenectomies or even nephrectomies. The industry, for its part, has developed tools that are increasingly better suited to children, even the newborns ones.

Optimal anesthetic and especially analgesic load allowing accompanying an early rehabilitation after laparoscopy remains little studied.

Early Postoperative Rehabilitation

At the, a large number of visceral surgery acts are performed by laparoscopy, for children of all ages, including newborns, with very good results thanks to a trained surgical team, young and very motivated. We have therefore developed this EPP in order to identify the anesthetic factors and surgery influencing early postoperative rehabilitation.

Methods for Laparoscopy

Patient Selection

The study concerns all intra and retroperitoneal laparoscopies. This is a retrospective uni-centric study carried out using PMSI data from Hospital between 01/01/2009 and 09/18/2009.

Different factors identified:

§   Preoperative data:

o   Age

o   ASA score

o   Existence or not of chronic preoperative pain and

o   Extent of surgery

For a more homogeneous analysis, the Types of Surgery classifies into:

o   Localized (1 quadrant)

o   Extensive (>1 quadrant) and

o   Generalized surgery

According to data from a pediatric study

§   Intraoperative data:

o   Duration Of Surgery

o   Number Of Non-Morphine Analgesics Administered And

o   Regional Analgesia (ALR)

§   Postoperative data:

o   Titration of morphine in SSPI (post-interventional surveillance room)

o   PCA (Patient Controlled Analgesia) of morphine

o   Administration of nalbuphine

o   Number of non-morphine analgesics

o   Complications surgical

o   The time to resume eating and

o   The length of hospitalization

We then studied the influence of these factors on two recognized markers of postoperative rehabilitation.

Statistical Analysis of Postoperative Rehabilitation

This analysis does with SPSS 15.0 software. A threshold of 5% considers significant for the different comparisons. Results expresses as mean ± standard deviation (M ± SD).

Statistical analysis used univariate analysis by ANOVA or Pearson linear regression. The factors found to be significant in this first analysis enters into a logistic regression model. These two steps repeat for the choosing analysis of each of the two markers of postoperative rehabilitation.

Conclusion

The stated objective of this approach is the establishment of care protocols and a research program in the field of postoperative rehabilitation after pediatric laparoscopic surgery. The advantages of the technique in children are substantially the same as in adults, with early postoperative rehabilitation and shorter hospital stays, as shown by the results of several recent trials.

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