Objective: Laparoscopic surgery in children is often hampered by limited working space. This is partially compensated by stretching the child's abdominal wall. The volume of space that can be gained and changes to abdominal wall elasticity with respect to age are unknown. In the current research, we studied the extent of abdominal wall elasticity while establishing pneumoperitoneum in children.
Methods: One hundred and sixty three children less than 18 years of age, undergoing elective laparoscopic surgery were recruited for the study. After induction of general anesthesia with a standardized muscle relaxant dose, a length of 5 cm was marked above, below and lateral to the umbilicus. The length of the marking was measured under increasing intraabdominal pressure (IAP of 0, 4, 6, 8, 10, 12 mmHg). The measurements were repeated to assess the effect of prestretching. The patients were divided into two groups: infants (less than one year of age) and older children (more than one year of age).
Results: Depending on the age and axes of the measurements, a child's abdomen stretches up to 17% on average, with induction of pneumoperitoneum. The percentage of stretch tapers off as the IAP approaches peak pressure. As children become older, the longitudinal abdominal wall elasticity decreases, but the transverse abdominal wall elasticity increases. Regardless of age, prestretching results in a statistically significant increase in the elasticity over the transverse and lower sagittal abdominal wall.
Conclusion: A child's abdominal wall has considerable expandability. The characteristics of elasticity change depending on the axis and age. Prestretching can improve intraabdominal working space. This knowledge is helpful in port position design for minimally invasive surgery in children.
Level of evidence: Level II.
Keywords: CO(2) pneumoperitoneum; Elasticity of abdominal wall; Intraabdominal pressure; Pediatric laparoscopic surgery; Prestretching.
Copyright © 2019. Published by Elsevier Inc.