The risks of minimal access surgery in children: an aid to consent

Aim: The aim of this study was to determine the risk of complications and conversions for minimally invasive procedures in children, thus allowing properly informed consent. Methods: Data were retrieved for all minimally invasive surgical procedures performed between 1995 and 2009. Results: There were 2352 cases performed in 2288 (1428 were male) patients. Of these, 2210 cases (94%) were laparoscopic, and 143 (6%), thoracoscopic. The median age at operation was 6 years and 4 months. The overall complication rate was 3.6%, with the risk of early reoperation at 1.7%. The risk was highest for fundoplication and pyloromyotomy at 3.2% and 4%, respectively. The risk of an infective complication was 0.5% and was highest for appendicectomy and nephrectomy. The risk of visceral injury overall in this series was 0.4%. Visceral injury, explicable only by port insertion, occurred in just under 1 in 1000 cases. The conversion rate was 2.3%. The lowest rates were observed with appendicectomy, fundoplication, and pyloromyotomy. Thoracoscopic cases, nephrectomies, and procedures for an underlying oncological diagnosis had a higher conversion rate. Conclusion: Informed consent requires knowledge of the risks of surgery. This series may serve as an aid for other units in obtaining consent for minimally invasive surgery in the pediatric population. (C) 2012 Elsevier Inc. All rights reserved.