Complicated appendicitis in children: is laparoscopic appendectomy appropriate? A comparative study with the open appendectomy—our experience

Wang, Xiaolin; Zhang, Wen; Yang, Xiaojin; Shao, Jinfan; Zhou, Xuefeng; Yuan, Jianming

doi:10.1016/j.jpedsurg.2009.03.037

Cited by 75 publications

(58 citation statements)

References 22 publications

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“…Many previous reports comparing LA and OA did not analyze readmission rates [9][10][11]. The hospital stay of LA was 5 days in our study and less than 7 days in most other studies [10][11][12]. Taking account of the fact that IAA usually develops 7 to 10 days after surgery, late development of IAA can be missed if readmission is not analyzed during the data review period, especially in a retrospective study.…”

Section: Discussioncontrasting

confidence: 52%

“…Some authors suggested copious irrigation of four quadrants and interloop areas with at least 3 L of sterile saline, leaving 300 to 500 mL of saline inside the peritoneal cavity at the end of the procedure, and also the application of a drain [14]. On the other hand, Wang et al [10] has recommended irrigation using copious amounts of fluid containing metronidazole. However, recent studies compared irrigation versus suction alone in perforated appendicitis in children suggested that irrigation of peritoneal cavity has no advantage [15,16].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Surgical Infection and Readmission Rates after Laparoscopy in Pediatric Complicated Appendicitis

Boo

Lee

et al. 2014

J Korean Assoc Pediatr Surg

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Purpose: Laparoscopic appendectomy (LA) has become a gold standard for children even in complicated appendicitis. The purpose of this study was to compare the postoperative surgical site infection rates between laparoscopic and open appendectomy (OA) group in pediatric complicated appendicitis. Methods: A total of 1,158 pediatric patients (age ≤15 years) underwent operation for appendicitis over a period of 8 years. Among these patients, 274 patients (23.7%) were diagnosed with complicated appendicitis by radiologic, operative and pathologic findings, and their clinical outcomes were retrospectively analyzed. Results: Of the 274 patients with complicated appendicitis, 108 patients underwent LA and 166 patients underwent OA. Patients in the LA group returned to oral intake earlier (1.9 days vs. 2.7 days; p＜0.01) and had a shorter hospital stay (5.0 days vs. 6.3 days; p＜0.01). However, rate of postoperative intra-abdominal infection (organ/space surgical site infection) was higher in the LA group (LA 15/108 [13.9%] Conclusion:The minimally invasive laparoscopic technique has more advantages compared to the open procedure in terms of hospital stay and early recovery. However, intra-abdominal infection and readmission rates were higher in the laparoscopy group. Further studies should be performed to evaluate high rate of organ/space surgical infection rate of laparoscopic procedure in pediatric complicated appendicitis.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Comparison of Surgical Infection and Readmission Rates after Laparoscopy in Pediatric Complicated Appendicitis

Boo

Lee

et al. 2014

J Korean Assoc Pediatr Surg

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“…For LA the operative time was significantly more compared to OA. 7 The patients in LA group had shorter stay in the hospital, started feeding earlier as well as the incidence of wound infection was lower when they compared to the patients in the OA group.…”

Section: Discussionmentioning

confidence: 81%

Study of laparoscopic appendectomy: advantages, disadvantages and reasons for conversion of laparoscopic to open appendectomy

2017

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Background:Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. Objective was to study the efficacy of laparoscopic appendectomy.Methods: A Hospital based cross sectional study was carried out among of 302 patients. The study duration was from June 2004 to December 2006. Institutional Ethics Committee permission was obtained. Informed individual consent was taken. Out of 302 subjects, 236 underwent open appendectomy and 66 underwent laparoscopic appendectomy.Results:It was observed that in both the groups majority patients had retrocecal position of the appendix. The amount of blood loss, adjacent organ injury and duration of surgery were similar in both the groups. The difference in the incidence of wound infection in both groups was not found to be statistically significant. But the antibiotic use was significantly less in the LA group compared to OA group. It was found that time to resumptions of oral fees, duration of hospital stay and time to return to normal duties were significantly lesser in LA group compared to OA group. (p < 0.001). As per the cosmetic end result, majorities were satisfied in LA group and rated the surgery as excellent as compared to patients in OA group.Conclusions:Laparoscopic appendectomy was better than open appendectomy with respect to wound infection, tackling co-existing pathology, duration of hospital stay, earlier return to normal activity, excellent cosmetic end result, lesser use of antibiotics and earlier resumption of oral feeds.

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“…Wenn man die Gradierung der Komplikationen nach Clavien durchführt, dann kommt es nach einer Cochrane-Analyse aus dem Jahr 2004 bei den Patienten in der laparoskopischen Gruppe allerdings zu einer erhöhten Inzidenz intraabdomineller Abszesse (Komplikation Level 3 - Reintervention oder Reoperation) gegenüber einer erhöhten Rate an Level-1-Komplikationen in der offenen Gruppe (vor allem Wundinfekte) [21]. Frühere Berichte [22] über eine erhöhte intraabdominelle Abszessrate bei Patienten mit perforierter Appendizitis konnten jedoch in neueren prospektiv randomisierten Studien, in denen sich im Gegenteil eine reduzierte Abszessrate bei erwachsenen und pädiatrischen Patienten in der laparoskopischen Gruppe zeigte, nicht mehr nachvollzogen werden [23,24]. Im Fall einer perforierten laparoskopischen Appendizitis reduziert eine intraabdominelle Spülung nach derzeitiger Datenlage nicht die Inzidenz postoperativer Abszesse [25], wobei die derzeitige Evidenzlage hier bisher keine eindeutige Empfehlung erlaubt.…”

Section: Spezielles Vorgehen Bei Bestimmten Krankheitsbildernunclassified

Grenzen des laparoskopischen Operierens bei abdomineller Sepsis

Keck¹,

Wellner²,

Tittelbach-Helmrich³

et al. 2013

Visc Med

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Hintergrund: Zahlreiche präklinische Daten weisen auf Vorteile des laparoskopischen Operierens auch bei abdomineller Sepsisquelle und septischem Patienten hin. Methode und Ergebnisse: Anhand derzeit verfügbarer Literatur betrachten wir die Möglichkeiten und Limitierungen laparoskopischen Operierens beim septischen Patienten mit abdominellem Fokus. Neben generellen Überlegungen werden im Speziellen das Vorgehen bei Appendizitis, Cholezystitis, perforiertem Ulkus, Sigmadivertikulitis und akuter Pankreatitis erörtert. Schlussfolgerungen: Erfahrene laparoskopische Chirurgen können die Sanierung der abdominellen Sepsisquelle bei Appendizitis, Cholezystitis, perforiertem Ulkus oder auch Sigmadivertikulitis sicher durchführen. Kombinationen aus interventionellen Techniken und minimal invasiven Operationen bieten insbesondere bei der perforierten Sigmadivertikulitis und bei infizierten Pankreasnekrosen innovative Ansätze, die derzeit in multizentrischen prospektiven Studien untersucht werden.

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Complicated appendicitis in children: is laparoscopic appendectomy appropriate? A comparative study with the open appendectomy—our experience

Cited by 75 publications

References 22 publications

Comparison of Surgical Infection and Readmission Rates after Laparoscopy in Pediatric Complicated Appendicitis

Comparison of Surgical Infection and Readmission Rates after Laparoscopy in Pediatric Complicated Appendicitis

Study of laparoscopic appendectomy: advantages, disadvantages and reasons for conversion of laparoscopic to open appendectomy

Grenzen des laparoskopischen Operierens bei abdomineller Sepsis

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