Meguerditchian AN, Prasil P, Cloutier R, et al. Laparoscopic appendectomy in children: a favorable alternative in simple and complicated appendicitis

Sainte-Foy Québec.
Journal of Pediatric Surgery (Impact Factor: 1.31). 05/2002; 37(5):695-8. DOI: 10.1053/jpsu.2002.32255
Source: PubMed

ABSTRACT The laparoscopic treatment of pediatric appendicitis remains controversial, particularly in complicated cases (gangrene and perforation). This study evaluates outcomes of open (OA) and laparoscopic appendectomy (LA).
The 391 cases of pediatric appendectomy performed between January 1998 and January 2001 were reviewed for age, sex, weight, type and length of intervention, operative description, antimicrobial therapy, analgesia, complications, length of hospitalization, and histopathology.
A total of 126 patients were operated on by laparoscopy, 262 by laparotomy, and there were 3 conversions (LA + OA). LA patients were older (11.9 v 9.6 years; P <.001) and more frequently girls (57.1% v 38.2%; P =.0004). LA took longer to perform (45.7 v 40.6 minutes; P =.0014). Operatively, 24.6% of LAs were described as complicated compared with 22.5% in OA. Narcotic use was equivalent in both groups (1.16 v 1.29 days; P =.434), as was the incidence of complications, either operative (1.6% v 0.4%; P =.20) or postoperative (10.3% v 8.02%; P =.32). Hospitalization was shorter in LA (2.38 v 2.94 days; P =.0131). Histopathology was negative in 21.4% of LAs compared with 13% of OAs (P =.032).
Laparoscopic appendectomy does not increase the incidence of complications, even with gangrenous or perforated appendicitis. The length of intervention is prolonged by 5 minutes on average. This technique allows for a shorter hospitalization.

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Available from: Ari-Nareg Meguerditchian, Aug 18, 2015
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    • "Since then a series of reports came out with restrained enthusiasm for laparoscopy [2] [3] [4] [5] [6]. In children, the doubts were more pronounced especially in complicated cases [7] [8] [9] [10] [11]. However practice of laparoscopy increased with passage of time and its superiority over open technique is now well established in terms of morbidity, recovery, wound infections, hospital stay, and utility in young females and obese children [6, 12–15]. "
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    ABSTRACT: Background. Since the latter half of 1980s laparoscopy has become a well accepted modality in children in many surgical procedures including appendectomy. We present here the experience of laparoscopic appendectomy in children in a tertiary care hospital in Bangladesh. Subjects & Methods. From October 7, 2005 to July 31, 2012, 1809 laparoscopic appendectomies were performed. Laparoscopy was performed in all the cases using 3 ports. For difficult and adherent cases submucosal appendectomy was performed. Feeding was allowed 6 h after surgery and the majority was discharged on the first postoperative day. The age, sex, operative techniques, operative findings, operative time, hospital stay, outcome, and complications were evaluated in this retrospective study. Results. Mean age was 8.17 ± 3.28 years and 69% were males. Fifteen percent were complicated appendicitis, 8 cases needed conversion, and 27 cases were done by submucosal technique. Mean operating time was 39.8 ± 14.2 minutes and mean postoperative hospital stay was 1.91 days. About 5% cases had postoperative complications including 4 intra-abdominal abscesses. Conclusions. Laparoscopic appendectomy is a safe procedure in children even in complicated cases.
    03/2014; 2014:125174. DOI:10.1155/2014/125174
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    • "Up until 1983, when LA was introduced, OA has been the criterion standard for the treatment of acute appendicitis [1]. Laparoscopic appendectomy is a well-documented procedure both in adults and in children and is generally considered a safe and effective alternative to open appendicitis [2] [3]. Many studies have favored the laparoscopic approach because of the improved aesthetic results, decreased postoperative pain, shorter recovery time, shorter postoperative hospitalization, and lower rate of wound infection [4] [5]. "
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    ABSTRACT: The purpose of the study was to determine and evaluate the incidence of postoperative bowel obstruction (PBO) after laparoscopic and open appendectomy in children. The medical files of children who have undergone an appendectomy, either via the laparoscopic or open approach, at our department from 1992 until 2007 were reviewed. Collected data included age at appendectomy, initial surgical approach, time interval to PBO, and type of definitive treatment. The incidences of PBO after laparoscopic and open appendectomy were compared with the chi(2) analysis. From the 1684 children who were found, 1371 had nonperforated appendicitis and 313 had perforated appendicitis. Laparoscopic appendectomy was performed in 954 patients of the nonperforated group and in 221 of the perforated group. Open appendectomy was performed in 417 and 92 patients of the 2 groups, respectively. Overall, the incidence of PBO development was 2.2%. In the laparoscopic appendectomy population, a significantly low incidence of 1.19% of PBO development was detected, compared with the 4.51% of the open appendectomy group (P < .0001). Laparoscopic appendectomy diminishes the potential of PBO development. The overall incidence of PBO is not related to the severity of the disease but only to the initial operative approach.
    Journal of Pediatric Surgery 08/2009; 44(8):1581-5. DOI:10.1016/j.jpedsurg.2008.11.049 · 1.31 Impact Factor
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    • "Since the introduction of laparoscopic appendectomy (LA) in the early 1980s [1], several studies have compared LA to traditional open appendectomy (OA). These studies have described advantages of the laparoscopic approach including smaller incisions with reduced scarring, faster recovery, decreased postoperative pain, lower rate of wound infections, and shorter postoperative hospitalization [2] [3] [4] [5]. "
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    ABSTRACT: Adhesive small bowel obstruction (SBO) is a common postoperative complication. Published data in the pediatric literature characterizing SBO are scant. Furthermore, the relationship between the risk of SBO for a given procedure is not well described. To evaluate these parameters, we reviewed the incidence of SBO after laparoscopic appendectomy (LA) and open appendectomy (OA) performed at our institution. With institutional review board approval, all patients that developed SBO after appendectomy for appendicitis from January 1998 to June 2005 were investigated. Hospital records were reviewed to identify the details of their postappendectomy SBO. The incidences of SBO after LA and OA were compared with chi2 analysis using Yates correction. During the study period, 1105 appendectomies were performed: 477 OAs (8 converted to OA during laparoscopy) and 628 LAs. After OA, 7 (6 perforated appendicitis) patients later developed SBO of which 6 required adhesiolysis. In contrast, a patient with perforated appendicitis developed SBO after LA requiring adhesiolysis (P = .01). The mean time from appendectomy to the development of intestinal obstruction for the entire group was 46 +/- 32 days. The overall risk of SBO after appendectomy in children is low (0.7%) and is significantly related to perforated appendicitis. Small bowel obstruction after LA appears statistically less common than OA. Laparoscopic appendectomy remains our preferred approach for both perforated and nonperforated appendectomy.
    Journal of Pediatric Surgery 07/2007; 42(6):939-42; discussion 942. DOI:10.1016/j.jpedsurg.2007.01.025 · 1.31 Impact Factor
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