Laparoscopic appendectomy in children: Report of 1,379 cases

El-Ghoneimi, Alaa; Valla, Jean Stéphane; Limonne, B.; Valla, V.; Montupet, Philippe; Chavrier, Y; Grinda, A

doi:10.1016/0022-3468(94)90371-9

Cited by 117 publications

(84 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[12,[18][19][20] The negative appendicectomy rate was 5%, which is quite low. [21][22] The mean age at diagnosis of AA was similar to those reported in other studies. [11,12,19] However, children with complicated AA were significantly younger than those with simple AA.…”

Section: Discussionsupporting

confidence: 87%

White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

Monsalve

Ellwanger²,

Montedónico

2017

S Afr Med J

View full text Add to dashboard Cite

Background. Acute appendicitis (AA) is the most common acute surgical condition of the abdomen, and the most commonly misdiagnosed. Objective. To analyse the white blood cell count (WBCC) and C-reactive protein (CRP) contribution to the diagnosis of AA in children.Methods. This was a retrospective study of 943 consecutive patients operated on with the preoperative diagnosis of AA, in whom preoperative WBCC and CRP had both been measured. Postoperatively, the patients were divided into three groups: normal appendix (no AA), simple AA and complicated AA. Results. Of the 943 patients, 616 (65.3%) had simple AA. The mean (standard deviation (SD)) age for this group was 9.8 (3.2) years (p<0.01 v. complicated AA), the mean WBCC was 16.5 (5.0) × 10 9 /L (p<0.01 v. complicated AA and no AA), and the mean CRP level was 304.8 (409.5) nmol/L (p<0.01 v. complicated AA). The mean age of the patients with complicated AA (283/943, 30.0%) was 7.9 (3.7) years, the mean WBCC was 17.7 (6.2) × 10 9 /L (p<0.01 v. no AA) and the mean CRP level was 1 076.2 (923.8) nmol/L (p<0.01 v. no AA). The mean age of the patients with no AA (44/943, 4.7%) was 8.8 (3.2) years, the mean WBCC was 13.1 (5.3) × 10 9 /L and the mean CRP was 361.9 (447.6) nmol/L. The WBCC was normal in 113/899 patients with appendicitis (12.6%) and CRP in 139 (15.5%). Both the WBCC and CRP were normal in 17 patients with appendicitis (1.9%). The best receiver operating characteristic (ROC) curve was obtained for WBCC when comparing all AA with no AA: cut-off point 15.0 × 10 9 /L, sensitivity 65%, specificity 68%, area under the curve 0.70. The best ROC curve for CRP was obtained when comparing simple AA with complicated AA: cut-off point 361.9 nmol/L, sensitivity 74%, specificity 74%, area under the curve 0.81. Conclusions. The WBCC is helpful in diagnosing simple AA and CRP in diagnosing complicated AA. If both are normal, AA is very unlikely. Together the WBCC and CRP are useful tools in diagnosing and staging AA. RESEARCHPostoperatively, all patients included in the study were divided into three groups according to the intraoperative macroscopic findings, as follows:• Normal appendix (no AA). All patients operated on with the preoperative diagnosis of AA but in whom the appendix was found to be macroscopically normal. The findings on histological analysis of the appendix in this group were recorded. • Simple AA. All non-perforated AA.• Complicated AA. Perforated appendix, peritonitis, appendicular abscess and appendicular mass. Statistical analysisMeans (standard deviations (SDs)) were used to describe the numerical variables. Statistical analysis was performed with parametric tests (Student's t-test or analysis of variance). A cross-sectional analysis of the diagnostic tests was performed where sensitivity, specificity and likelihood ratios were calculated. Receiver operating characteristic (ROC) curves were also elaborated for each test and prediction, calculating the area under the curve with a confidence interval of 95%. The level of significance was set at p<0....

show abstract

Section: Discussionsupporting

confidence: 87%

White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

Monsalve

Ellwanger²,

Montedónico

2017

S Afr Med J

View full text Add to dashboard Cite

show abstract

“…Laparoscopic appendectomy has been reported to have advantages when compared with the open approach, including faster recovery time, less scarring, shorter postoperative hospitalization, and a decreased incidence of small bowel obstruction [11][12][13]. Others have found no benefit for the laparoscopic approach [14].…”

Section: Discussionmentioning

confidence: 99%

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Keckler

Tsao

Sharp

et al. 2008

Journal of Pediatric Surgery

View full text Add to dashboard Cite

Objective-Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial.Methods-After institutional review board approval, a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006. Continuous variables are listed with standard deviation.Results-There were 52 patients with a mean age of 9.0 ± 3.9 years and weight of 34.4 ± 18.8 kg. The mean duration of symptoms at presentation was 8.4 ± 7.6 days. Percutaneous aspiration only was performed in 2 patients. The mean volume of fluid on initial aspiration/drain placement was 76.3 ± 81.1 mL. The mean time to appendectomy was 61.9 ± 25.2 days. The laparoscopic approach was used in 49 patients (94.2%), of which one was converted to an open operation. The mean length of hospitalization after interval appendectomy was 1.4 ± 1.4 days. A recurrent abscess developed in 17.3% of the patients. Six patients (11.5%) required another drainage procedure. The mean total charge to the patients was $40,414.02. There were 4 significant drain complications (ileal perforation, colon perforation, bladder perforation, and buttock/thigh necrotizing abscess).The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy.Conclusions-The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach. However, this management poses complication risks and uses considerable resources. Therefore, this strategy should be compared with early operation in a prospective trial.

show abstract

“…19,20 Although the technique described here can be completed via a laparotomy, the laparoscopic approach provides the benefits of a minimally invasive approach, including better visualization of the diaphragm, decreased length of stay, minimal scarring, and decreased postoperative need for analgesia. 21,22 The main limitation to this technique lies with size of the patient. As the endostapler must pass through a 12-mm port, the child must be large enough to accommodate not only the port, but also the smallest size endostapler available, which is 35 mm.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Transperitoneal Repair of Pediatric Diaphragm Eventration Using an Endostapler Device

Lao

Abdessalam

2013

Journal of Laparoendoscopic & Advanced Surgical Techniques

View full text Add to dashboard Cite

Background: Minimally invasive repairs of pediatric diaphragm eventration have been well described via a thoracoscopic approach, oftentimes requiring single-lung ventilation and tube thoracostomy, with the disadvantage of not being able to clearly visualize what lies beneath the diaphragm. We describe a novel pediatric diaphragm eventration repair using a laparoscopic transperitoneal approach and an endostapler device. We also describe our initial experience with this technique. Patients and Methods: Four pediatric diaphragmatic eventration patients underwent laparoscopic transperitoneal repair using an endostapler device. Repairs were performed in both male and female patients with rightsided eventrations. We approach the repair in a transperitoneal fashion using inverting sutures at the apex of the diaphragm to create tension toward the pelvis. Subsequently, an endostapler is used to remove the redundant portion of diaphragm, leaving a repaired, taut diaphragm. Results: The median age at operation was 10.5 months. The median operative time was 70 minutes. There was no mortality, surgical complications, or recurrence at a median follow-up of 17 months. Conclusions: This laparoscopic approach allows for clear visualization of the intraabdominal organs and, at least in our early experience, a very simple, straightforward operation. Additionally, with the use of the endostapler, the redundant, often weakened diaphragm is removed, leaving the native, healthy diaphragm behind, resulting in a reliable and reproducible repair. This repair should be considered as a feasible alternative approach to the more traditional open and thoracoscopic repairs.

show abstract

Laparoscopic appendectomy in children: Report of 1,379 cases

Cited by 117 publications

References 10 publications

White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Laparoscopic Transperitoneal Repair of Pediatric Diaphragm Eventration Using an Endostapler Device

Contact Info

Product

Resources

About