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: 1.39). 05/2002; 37(5):695-8. DOI: 10.1053/jpsu.2002.32255
Source: PubMed


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
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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.
    Full-text · Article · Mar 2014 · Minimally Invasive Surgery
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    • "However, the incidence of intra-abdominal abscess in cases of complicated appendicitis was reported to be increased during laparoscopy compared to that for an open approach.2,3 There is a debate regarding the use of LA to treat perforated or complicated appendicitis in children.5-7 In recent reports of complicated appendicitis in children, LA was considered the treatment of choice.8-13 "
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    ABSTRACT: Purpose This study evaluated the feasibility of a laparoscopic approach in children with generalized peritonitis secondary to perforated appendicitis. Materials and Methods We retrospectively analyzed the medical records of patients who underwent laparoscopic appendectomy with drainage for generalized peritonitis secondary to perforated appendicitis at our hospital between September 2001 and April 2012. Laparoscopic outcomes were compared with outcomes of an open method for perforated appendicitis. Results Ninety-nine patients underwent laparoscopic appendectomy (LA) for generalized peritonitis from perforated appendicitis, and 87 patients underwent open appendectomy (OA) for perforated appendicitis. Wound infection was more common in the OA group (12.6%) than in the LA group (4.0%; p=0.032). The incidence of intestinal obstruction during long-term follow-up was significantly higher in the OA group (4.6% vs. 0.0% in the LA group; p=0.046). LA was possible in most patients for whom LA was attempted, with a conversion rate of 10.8%. Conversion to OA was affected by the preoperative duration of symptoms and the occurrence of intraoperative complications. Conclusion LA is feasible for use in children with generalized peritonitis from perforated appendicitis, with reasonable open conversion and perioperative complication rates comparable to those of the OA group.
    Full-text · Article · Nov 2013 · Yonsei medical journal
    • "In open surgery, atypical localisation of the appendix or inaccurate diagnosis may require an extension of the incision as well. The laparoscopic approach also allows patients to become mobile and pain-free much faster, due to less trauma to the muscles and fascia.[24] Another advantage of laparoscopy lies in a 30% lower rate of adhesions, which is a particularly common late complication, especially in children with perforated appendicitis.[25] "
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    ABSTRACT: Laparoscopic appendectomy is becoming the preferred technique for treating acute appendicitis. However, its role in the treatment of complicated appendicitis is controversial. This study was undertaken to assess the feasibility of laparoscopic appendectomy for appendicular mass. A retrospective review was performed of all the patients who were treated laparoscopically for appendicular mass from March 2007 to October 2009. Tertiary care hospital. A total of 120 patients were treated for appendicitis. A retrospective review of the patients' records demonstrated that 19 patients (15.8%) had appendicular mass at the time of admission. The average operative time was 95 minutes (range 45-140 minutes). Pathological evidence of appendicitis was present in all the patients. The average length of hospital stay was six days (rang 6-9 days). Three patients (15.7%) had post- operative complications. Two patients developed wound infections and one patient was re-admitted with pain and a lump below the umbilical port. The findings suggest that laparoscopic appendectomy is feasible in patients with appendicular mass. The authors propose a prospective, randomized trial to verify this finding.
    No preview · Article · Apr 2011 · Journal of Minimal Access Surgery
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