National trends in therapeutic approaches and outcomes for pediatric appendicitis: a Taiwanese nationwide cohort study

Abstract

Our study demonstrated that young age and perforated appendicitis can affect postoperative IAA and PBO. LA appeared beneficial in reducing the length of hospitalization and postoperative IAA, but had an increasing risk of PBO. Although laparoscopic approach for pediatric appendectomy is increasing in our country, the different hospital levels and pediatric surgeon's laparoscopic experience must be evaluated in further study.

A population‐based comparison of the post‐operative outcomes of open and laparoscopic appendicectomy in children

“…During the past 20 years, laparoscopic appendicectomy has become the standard procedure for treating acute appendicitis in children 4 . Our finding that 86% of cases were managed with laparoscopic appendicectomy in 2013 is similar to reported rates in the United States (2010, 90%) 8 and the Netherlands (2010, 94%), 9 and higher than in Germany (2010–2012, 76%), 10 Canada (2010, 66%) 11 and Taiwan (2012, 57%) 12 …”

“…4 Our finding that 86% of cases were managed with laparoscopic appendicectomy in 2013 is similar to reported rates in the United States (2010, 90%) 8 and the Netherlands (2010, 94%), 9 and higher than in Germany (2010e2012, 76%), 10 Canada (2010, 66%) 11 and Taiwan (2012, 57%). 12 The post-operative outcome rates we report are only partially consistent with the findings of the most recent relevant systematic review, which pooled the results of 19 studies (2000e2011) encompassing 107 000 children. 5 For children with uncomplicated appendicitis, the authors of the systematic review found no differences between the two operation types with regard to the overall incidence of post-surgery complications and the odds of intestinal obstruction.…”

“…5 A recent German populationbased study of 8110 patients also reported that the risk of re-admission for complications was reduced after laparoscopic appendicectomy. 10 We found no association between surgical technique and intra-abdominal abscess, and the findings of other studies have been inconsistent, 5,9,12 perhaps because of differences in peri-operative management, surgical technique, and the reporting of intra-abdominal abscess. This is highlighted by the results of our sensitivity analysis: after cases of appendicitis with localised peritonitis (milder complicated cases) were excluded, differences in the odds of post-operative complications between open and laparoscopic appendicectomy were no longer evident.…”

Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences

“…While it is reasonable to monitor patients with DM closely in light of general medical knowledge, the association of DM with post-appendectomy IAA development needs to be proved in future randomized controlled trials. For the pediatric patients, perforated appendicitis, obesity and age of 6 years or younger have been considered as risk factors for the post-appendectomy IAA, as proven by recent studies [13,14] . However, it may be inappropriate to make direct comparison between their results and ours as these studies have been conducted on juvenile patients, and the operative methods were different from ours.…”

“…Diabetes mellitus (DM), peritoneal irrigation during appendectomy, perforated appendicitis, obesity and young age are possible risk factors for the development of a post-appendectomy IAA [9][10][11][12][13][14] . However, the majority of studies investigating risk factors for post-appendectomy IAA are relatively small-sized studies, and patient characteristics appear to be inhomogeneous with respect to the operative method.…”