Adhesive small bowel obstruction after appendectomy in children – Laparoscopic versus open approach

Abstract

Background: The aims of this study were to compare the incidence of small bowel obstruction (SBO) requiring laparotomy after laparoscopic appendectomy (LA) and open appendectomy (OA) in children and to identify risk factors for SBO. Methods: Medical records of patients who underwent appendectomy from 2000 to 2014 at our department of Pediatric Surgery were reviewed. Risk factors were analyzed using Cox proportional hazard regression. Results: Totally 619 out of 840 patients were included. OA was performed in 474 (76.6%), LA in 130 patients (21%), and 15 (2.4%) were converted from LA to OA. Age, sex and proportion of perforated appendicitis were comparable in the LA and OA groups. Median follow-up time was 11.4 years (2.6-18.4). The incidence of SBO after LA was 1.5%, after OA 1.9% and in the converted group 6.7% (p = 0.3650). There were no significant differences in the incidence of postoperative intraabdominal abscess, wound infection or length of stay between LA and OA. Perforation and postoperative intra-abdominal abscess were identified as risk factors with 9.03 (p b 0.001) and 6.98 (p = 0.004) times higher risk of SBO, respectively. Conclusions: The risk for SBO after appendectomy in children was significantly related to perforated appendicitis and postoperative intra-abdominal abscess and not to the surgical approach. Level of Evidence: Level III.

Treatment of jejunoileal atresia by primary anastomosis or enterostomy: Double the operations, double the risk of complications

“…The main reason for enterostomy creation is intestinal perforation or meconium peritonitis, but a prime reason to develop an enterostomy instead of a primary anastomosis is the fear of anastomotic leakage. However, enterostomy formation in paediatric cases in general is associated with multiple short-and long-term complications such as surgical site infections, incisional hernia and adhesive small bowel obstruction resulting in the use of extra antibiotic treatment or even repeated or emergency surgery (10,11).…”

Appendiceal Adenocarcinoma Presenting As Perforated Appendicitis

“…According to Håkanson, a relationship between perforated appendicitis and adhesive small bowel obstruction may be explained by the adhesions formed to nearby structures, and dissection of the inflammatory mass may require more manipulation of the tissue leading to a higher risk of further adhesion formation. Patients with perforation had 9.03 times higher risk of small bowel obstruction (p < 0.001), and patients with the development of an intra-abdominal abscess had 6.98 times higher risk of small bowel obstruction (p=0.004) [6].…”

Modern principles of diagnostic and treatment of acute appendicitis in children

“…Формування зростів у черевній порожнині є природним фізіологічним процесом унаслідок будь-якого хірургічного втручаннях, які у 4,5-20% дітей можуть проявлятися клінікою кишкової непрохідності [27,39]. За результатами нашого дослідження, частота виникнення тонкокишкової спайкової непрохідності в ранньому післяопераційному періоді статистично не відрізнялась у дітей, яких оперували традиційно чи лапароскопічно -0,7% і 0,3%, відповідно (р>0,05), що співпадає з даними літератури [27,29].…”

“…Це частково узгоджується з даними C.A. Håkanson зі співавторами (2020), які відмітили, що перфоративний апендицит зумовлений розвитком спайкової непрохідності у 25,5% пацієнтів[27]. На відміну від дослідження R.E.…”