Paediatric laparoscopic surgery

Modern technology means that invasive abdominal surgery for infants can mostly be avoided.This article provides information on the new laparoscopic techniques used to treat hernias and other complications in young children.



The use of tailor-made, smaller instruments in laparoscopic (keyhole) surgery means the surgeons can:

  • Get easier access to the baby’s organs
  • Make smaller incisions which in turn means tiny cuts for the baby instead of one large scar from an invasive procedure
  • Avoid complications from large scarring which can leave troublesome adhesions and require future surgery. As a result, the babies recover more quickly and normal family life can resume

Keyhole surgery in the abdomen is known as laparoscopy. This involves operating through tiny incisions with the help of a telescope and TV monitor. Over the last 20 years laparoscopy has replaced many traditional ‘open’ operations. This is due to the distinct advantages laparoscopy has for patients, such as:

  • Less pain after surgery
  • Quicker discharge from hospital
  • Quicker return to normal daily activities

While keyhole surgery is now readily available to adult patients for these reasons, it is not so readily available to children and infants, even though the advantages are just as relevant to this population. The surgery is technically demanding and takes patience, time and determination to master. Some surgeons have not been trained in this technique or have not learned the necessary skills and a small number of surgeons do not have the required hand-eye co-ordination.

However, thanks to developments in training and equipment almost all surgical conditions in the abdomen in children can be treated by keyhole surgery. Procedures that are appropriate for this type of minimally invasive approach range from common conditions such as inguinal hernia repair, to rarer conditions such as fundoplication for acid reflux. In this article I will discuss several conditions that can, and some that should only, be treated by keyhole surgery and describe the associated advantages to the child.

Conditions treatable using keyhole surgery

Inguinal hernia

Both boys and girls often present with groin swellings known as inguinal hernias. A hernia is the protrusion of an organ such as the intestine or ovary through the abdominal muscles, and an inguinal hernia appears as a bulge in the groin. To fix the hernia by keyhole surgery involves a small incision at the umbilicus which acts as the entry point for the camera and two tiny cuts on each flank. The umbilical incision is for the miniaturized camera / telescope and the two side incisions are for the working instruments, in this case a forceps and a needle-holder. The hernia defect is closed with a stitch, somewhat like closing the top of a purse by pulling the string. Sometimes there is a potential hernia on the other side, which has not yet developed in to a groin swelling, and this can be proactively ‘fixed’ at the same time. The older, traditional operation for inguinal hernia involves a larger cut in the groin skin and muscle. The hernia is then peeled from the sperm duct and vessels of the testicle (in boys) and sutured closed. So, the advantages of the new, keyhole technique include the following:

  • Skin and muscle incisions are small so there is less pain and scarring
  • The sperm duct and testicular vessels are not handled and therefore not at risk of being damaged
  • If there is a potential hernia on the other side then it can be fixed at the same time

Undescended testicle

Again, this is quite a common occurrence in babies. When the testicle is easily palpated, but is not in the scrotum, then a routine ‘orchidopexy’ can be performed, which involves fixing the testicle in the scrotum. However, if the testicle is not palpable, then laparoscopy is the best investigation. By looking inside the abdomen with the telescope, I can seen where the testicle is, or indeed, if it is present at all. No other investigations even including ultrasound, gives this level of diagnostic accuracy. In those cases where the testicle is present I can go on to reposition and fix it in place by passing it through the muscles and placing it in a little pocket in the scrotum.

Acute appendicitis

This is the commonest reason for emergency surgery in children. Treatment consists of antibiotics and surgery - appendicectomy. Laparoscopy allows the surgeon to confirm the diagnosis and remove the inflamed appendix. Traditional ‘open’ surgery involves a bigger incision in the abdominal wall with resulting discomfort and potential for infection.

Gallbladder stones

These are not as common in children as in adults and tend to be associated with blood disorders such as Sickle Cell disease. The gold standard operation for removing the gallbladder (and stones) is laparoscopic cholecystectomy, whereby the gallbladder is dissected from it’s bed in the liver and removed from the body. Again, this minimally invasive approach allows quicker recovery and leaves only tiny scars rather than bigger, unsightly scars associated with traditional surgery.


In certain cases it is necessary to remove the spleen in children with blood disorders. Laparoscopic splenectomy is safe and has all the usual advantages of keyhole surgery.


Children occasionally have very severe vomiting (gastro-oesophageal reflux disease), which causes chest infections and failure to thrive. Mostly, this can be treated with medicines, but an operation is sometimes needed. The operation is called a fundoplication and the safest option is to perform this procedure using keyhole surgery. The operation involves wrapping the top of the stomach (fundus) around the oesophagus to create a valve. The resulting structure prevents the reflux of acid from the stomach.


Minimal access surgery, such as the laparoscopic procedures mentioned above, is now accepted as the best and safest way to operate on babies and children. This special group of patients has their whole lives ahead of them and there is no longer any need for them to have to live with the scars of ‘open’ operations performed in their childhood.

The part of the body that contains the stomach, intestines, liver, gallbladder and other organs. Full medical glossary
Relating to the abdomen, which is the region of the body between the chest and the pelvis. Full medical glossary
An abnormal connection between two surfaces of the body. Full medical glossary
Medication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria. Full medical glossary
Inflammation of the appendix, a small tube attached to the large intestine. Full medical glossary
The organ that stores urine. Full medical glossary
A fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. Full medical glossary
The surgical removal of the gallbladder. Full medical glossary
A condition that is linked to, or is a consequence of, another disease or procedure. Full medical glossary
A fluid-filled, enclosed pouch developing in a bodily structure as part of a disease process Full medical glossary
The process of determining which condition a patient may have. Full medical glossary
The area of the body between the lowest rib and the hip. Full medical glossary
A viral infection affecting the respiratory system. Full medical glossary
The appearance of the retina when viewed through an opthalmoscope. Full medical glossary
Small pear-shaped organ that sits under the liver and that stores bile. Full medical glossary
When part of an organ pushes through the wall of the body cavity that normally holds it. Hernias can develop in many different parts of the body. Full medical glossary
Invasion by organisms that may be harmful, for example bacteria or parasites. Full medical glossary
Relating to the area around the groin. Full medical glossary
The section of gut, or gastrointestinal tract, from the stomach to the anus. Full medical glossary
A type of minimally invasive surgery. Full medical glossary
A keyhole surgical procedure. Full medical glossary
Keyhole surgery that uses an instrument called a laparoscope to examine the abdominal or pelvic organs. Full medical glossary
A large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats. Full medical glossary
Tissue made up of cells that can contract to bring about movement. Full medical glossary
The gullet, the part of the gastrointestinal system that extends down from the mouth cavity to the stomach. Full medical glossary
An operation to bring a testicle down into the scrotum. Full medical glossary
Medical examination by the hands and fingertips. Full medical glossary
Backflow of a bodily fluid in the wrong direction Full medical glossary
The sac that contains the testes. Full medical glossary
A mature male sex cell. Full medical glossary
An organ situated on the left side of the abdomen that filters out worn-out red blood cells and other foreign bodies from the bloodstream. Full medical glossary
The surgical removal of the spleen, an organ on the left side of the abdomen that filters out worn-out red blood cells and other foreign bodies from the bloodstream. Full medical glossary
the organ or the body where food is stored and broken down Full medical glossary
One of two male sex organs, also calles testes, that produce sperm and the hormone testosterone. Full medical glossary
Relating to the testicles. Full medical glossary
trichomonal vaginosis Full medical glossary
A diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. Full medical glossary
A structure that allows fluid to flow in one direction only, preventing backflow. Full medical glossary
Expusion of the contents of the stomach through the mouth. Full medical glossary