Laparoscopic or Open Appendectomy for Pediatric Appendicitis?

Abstract

Background: This study aimed to compare open appendectomy (OA) and laparoscopic appendectomy (LA) in children by analyzing the differences in outcomes between the two techniques. Materials and Methods:This was a single-institution retrospective study. Data were collected from the medical records of all children <15 years of age who underwent an appendectomy from 2006 through 2014. Preoperative parameters, appendicitis severity, surgery time, complications, pain treatment, and postoperative outcome including days of hospital stay were collected. LA was performed with a two-or three-port technique, and a McBurney incision was adopted for OA. Conversions were regarded as OA.Results: A total of 406 appendectomies were performed during the study period, 146 (36%) OA (61 conversions) and 260 (64%) LA. No differences were found between the two groups regarding surgery time, operative and postoperative complications, and postoperative pain treatment. In cases of Phlegmonous appendicitis, LA was associated with a significantly shorter median hospital stay than was OA (1 and 1.8 days, respectively; p < 0.01). Healthy and Phlegmonous appendices were more commonly treated with LA (p < 0.01 for both); gangrenous, perforated, and abscessed appendices were more commonly treated with open surgery (p = 0.02, p < 0.01, and p < 0.01, respectively). Conclusion:The study identified no disadvantages of LA compared with OA. Therefore, LA should be the preferred technique because it is associated with a shorter hospital stay for patients with Phlegmonous appendicitis and also allows inspection of the abdominal cavity, a major diagnostic advantage. result from lack of experience in the technique. This difference will decrease as surgeons receive more training in endoscopic surgery [15]. Keywords:Since the introduction of LA the use of this surgical method has increased, making it the method of first choice [9]. The long transition period and the continued use of both techniques are due to the split opinion among surgeons and the lack of experience in endoscopic surgery [9]. According to a 2008 national cohort study of children and adults, 33% of appendectomies began as LA and 66% began as OA [16]. In 1992, the rate of intended LA was only 4%; prior to that year the procedure was performed only sporadically [16]. In patients aged 0-9 years, 4% of appendectomies performed from 1992 to 2008 were laparoscopic; in those aged 10-19 years, the rate was 18% [16]. LA was performed less commonly in children than in the population as a whole (the LA rate for the total population from 1992 to 2008 was 20%) [16].The aim of this study was to compare OA and LA in children with regard to perioperative parameters and postoperative outcome. The intention was to provide information of value to surgeons making the decision to perform appendectomy for a child. The question is whether LA or OA leads to the better outcome when treating pediatric appendicitis. Materials and Methods Settings and childrenAll children underwent surgery at the Department o...