Pediatric Laparoscopic Surgery

Laparoscopic surgery in children offers numerous advantages: minimal postoperative pain, faster recovery, reduced hospitalization time, and almost no risk of postoperative bowel obstruction due to adhesions. It is considered a form of minimally invasive pediatric surgery.

The most commonly performed emergency procedure in pediatric surgery is laparoscopic appendectomy.

Among elective procedures, children’s laparoscopic surgery in Israel frequently includes laparoscopic inguinal hernia repair — now routinely performed even in infants.

The Pediatric Surgery Department at the Dana-Dwek Children’s Hospital in Tel Aviv Sourasky Medical Center prefers laparoscopic methods whenever possible. The staff is highly trained and experienced in these procedures.

Laparoscopic procedures performed include: gallbladder surgery, appendectomy, correction of undescended testes (cryptorchidism), inguinal hernia repair, spleen surgery, removal of small tumors, and surgeries involving the small and large intestines, as well as treatment of congenital anomalies.

Laparoscopic repair of inguinal hernias is indicated in several scenarios:

• During open hernia repair, laparoscopy is used to inspect the opposite side for a hidden hernia, and if found, bilateral repair is performed in a single session.
• Planned laparoscopic hernia repair in cases without incarceration.
• Emergency laparoscopic repair of incarcerated inguinal hernia.

Advantages of using pediatric laparoscopic surgery without waiting for hernia repair include:

• Better visualization of the affected bowel segment to assess for damage or necrosis.
• Inspection and possible simultaneous repair of a contralateral hernia.
• Reduced risk of injury to the spermatic cord and testicular vessels.
• Superior cosmetic outcomes compared to open surgery.

In 2018, the department successfully performed over 90 laparoscopic hernia repairs without complications, demonstrating the high standard of care at the Israel pediatric surgical center.

Another complex condition seen in pediatric patients, even infants, is Short Bowel Syndrome (SBS). This disorder impairs the gastrointestinal tract’s ability to absorb nutrients, posing serious risks to a child’s growth and development.

SBS may result from congenital or acquired causes, such as necrotizing enterocolitis, intestinal atresia, Hirschsprung’s disease, or volvulus due to malrotation. Other causes include trauma, tumor resection, fistulas, and scleroderma.

SBS is associated with severe complications like liver failure, bloodstream infections from central lines, gallstones, and malnutrition. Advances in parenteral nutrition, liver and bowel transplantation, and innovative surgeries have significantly improved survival.

The Dana-Dwek Pediatric Surgery Department is part of a specialized center for managing intestinal failure and SBS. A multidisciplinary team collaborates to balance enteral and parenteral nutrition, manage complications, and perform no wait pediatric surgery in Israel, including bowel lengthening.

The preferred method is Serial Transverse Enteroplasty (STEP), which widens and elongates the intestine, promoting adaptation and function of the gastrointestinal tract.