Outcome after introduction of laparoscopic appendectomy in children: A cohort study (original) (raw)
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Laparoscopic versus open appendectomy in complicated appendicitis in children: a single center study
Egyptian Pediatric Association Gazette
Background: Acute complicated appendicitis is a common abdominal emergency in children. Unlike simple appendicitis, laparoscopic appendectomy has not been considered yet the first choice in management of complicated appendicitis. This prospective randomized controlled clinical trial was conducted at Pediatric Surgery Department, Zagazig University Hospitals, Egypt, during the period from December 2018 to August 2019. The aim of the study was to evaluate the role of laparoscopic appendectomy in such cases compared to open appendectomy. Results: Sixty patients were included in the study, divided randomly into 2 equal groups: laparoscopic and open appendectomy groups. The mean operative time was significantly longer with laparoscopic appendectomy than open appendectomy, 85 vs. 61 min, respectively (p < 0.001**). The time taken to start oral intake was significantly shorter with laparoscopic appendectomy than open appendectomy, 1.9 vs. 2.73 days, respectively (p = 0.025*). The mean hospital stay was significantly lower with laparoscopic appendectomy than open appendectomy, 4.23 vs. 5.13, respectively (p = 0.044*). There were no statistical differences between the two groups regarding wound infection, occurrence of postoperative ileus, intraperitoneal collection, or readmission. Conclusions: Laparoscopic appendectomy is safe, feasible, and effective procedure in the management of complicated appendicitis in children, with no evidence of any increase in the postoperative complications. Background Acute appendicitis is considered one of the most common abdominal emergencies in children [1]. There is a high probability for occurrence of complications in this age group due to delay in diagnosis as a result of difficulty in communication and misdiagnosing with the more common gastrointestinal disorders [2, 3]. Open appendectomy (OA) through McBurney's incision [4] had been considered as the technique of choice in managing such cases for more than one century. Introduction of minimal invasive surgery provided many benefits that made most surgeons try to consider it an alternative procedure in different surgical situations [2]. The first laparoscopic appendectomy (LA) was performed by Semm, a German gynecologist in 1983 [5], while the first LA in children was performed in 1992 by Ure and coworkers [6]. Since that, many trials reported good outcomes with LA for uncomplicated appendicitis due to its advantages, especially faster return to normal activity, less postoperative pain, and decreased postoperative complications [7]. The advantages of laparoscopic appendectomy in complicated appendicitis have been reported by many studies [8-11]. On the other hand, others reported some disadvantages including intra-abdominal abscess and wound
African Journal of Paediatric Surgery: AJPS, 2021
Introduction: Acute appendicitis is the most common surgical emergency with a lifetime incidence of 7%–8%. There are two operative modalities that are currently used for the management of this condition in the paediatric population. The objective of this cohort study was to review the outcome of the management of paediatric surgical patients presenting with acute appendicitis after either an open appendectomy (OA) or laparoscopic appendectomy (LA) was performed. Methods: This was a 2-year retrospective study conducted from 01 January 2016 until 31 December 2017 on paediatric surgical patients < 13 years of age undergoing appendectomies. Eighty-one (n = 81) files of patients were reviewed, and data analysis was performed on two comparative groups namely the OA group and LA group, with the aid of the SAS system with statistical significance based on P < 0.05. Results: During the study period, 81 children (male: female ratio of 2:1) underwent appendectomies. Nearly 38% (n = 31) o...
The American surgeon, 2004
This is a retrospective outcomes analysis of pediatric open and laparoscopic appendectomy in a children's hospital. One hundred three children underwent appendectomy for appendicitis by two pediatric surgeons from August 1998 to December 2002. Patients were divided into two groups, laparoscopic appendectomy (LAP) and open appendectomy (OAP), and were further subdivided by diagnosis: normal (NL), acute (AA), and ruptured (RA). There were no differences in age, sex, race, or zip codes between groups. Median age was 10 years. In the acute phase, 28 patients underwent OAP and 65 underwent LAP whereas 10 patients underwent interval appendectomy (IA) 6 weeks after percutaneous drainage of established abscesses (eight were LAP vs two OAP). In the remaining patients, the appendix was normal in 17 (18.4%) and ruptured in 24 (25.8%) pathologically. LAP took longer to perform (57 minutes vs 34.5 minutes) at higher cost (3718 dollars vs 1858 dollars) than OAP. Overall complications were low...
The American Journal of Surgery, 2006
Background: Previous studies have suggested laparoscopy leads to an increased risk of postoperative intra-abdominal abscess formation in complicated appendicitis. The purpose of this study is to prospectively evaluate a standardized laparoscopic approach applied by a single surgeon for all children who present with appendicitis and to determine the postoperative outcome. Methods: Over a 5-year period (2001)(2002)(2003)(2004)(2005), all children presenting to the author with simple or complicated appendicitis were approached laparoscopically and their preoperative workup, intraoperative findings, and postoperative outcomes recorded. Results: One hundred seventy-five consecutive laparoscopic appendectomies were performed with no open conversions. Mean patient age was 9 years. Sixty-seven patients (38%) presented with complicated appendicitis. The overall complication rate was 6% (9 children developed a postoperative intra-abdominal abscess or phlegmon and 2 had umbilical wound infections). Conclusions: When laparoscopic appendectomy is used as the primary technique, only 6% of patients experience infectious complications. Therefore, a laparoscopic approach to all children presenting with appendicitis does not lead to an increased complication rate.
Laparoscopic Appendectomy Versus Open Appendectomy in Children: Evolution over Time
Acta Medica Transilvanica, 2021
Laparoscopic appendicitis surgery is accepted in more and more centers around the world. Studies and meta-analyses of studies have shown that laparoscopic appendicitis is a feasible and safe procedure with numerous clinical benefits, such as shorter postoperative ileus, lower incidence of wound infection, lower postoperative pain and duration, recurrence faster to activities. Because laparoscopic appendectomy has been associated with a reduced risk of surgical complications, it may provide a better alternative versus open surgery. A review of data relevant to the evaluation of laparoscopic appendectomy versus open appendectomy as reflected in the literature of the last 2 decades would be relevant for the growing progressive interest of laparoscopic surgery for acute appendicitis and for its comparative evaluation with classical open appendicitis intervention.
Ankara Üniversitesi Tıp Fakültesi Mecmuası, 2006
Aim: Laparoscopic management of pediatric appendicitis remains controversial. A retrospective chart review was performed to compare laparoscopic versus open approach in the treatment of childhood appendicitis. Patients and Methods: Three hundred thirty seven children who underwent appendectomy with preoperative diagnosis of appendicitis over a 36-month period were included to the study. Primary outcome measures were postoperative wound infection, intra-abdominal abscess formation and intestinal obstruction. Secondary outcome measures were the length of operation, time to oral feeding, analgesic need and hospitalization time. Results: Total number of children in laparoscopy group was 126 (39.8%) whereas this number for open group was 188 (59%). There were 3 (1%) conversions in laparoscopy group. Mean length of operative time for laparoscopic (LA: 52 ±1.34 min), and open appendectomy (OA: 54 ± 1.27min), were similar (p>0.05). Time to full enteral feeding (OA: 24 ±1.1h, LA: 14±0.5h), analgesic usage (OA: 48±5h, LA: 24±5h) and length of hospitalization (OA: 3.9±0.1 day, LA: 2.8±0.1 day) were shorter in laparoscopic group compared to the open procedure (p<0.05). Early postoperative complication rate as wound infection (OA: 2.5%, LA: 0.3%), intra-abdominal abscess formation (OA: 1.3%, LA: 0.3%) were higher in OA group (p<0.05). Adhesive intestinal obstruction in need of re-operation was encountered in 5 (1.6 %) children in OA versus none in LA (p<0.05). Similar results were obtained for simple and complicated appendicitis separately. Conclusions: Laparoscopic appendectomy is at least as safe and effective as open appendectomy in the management of childhood appendicitis. LA does not increase length of operation and offers a faster recovery. Postoperative complication rate is low compared to open approach.
Pediatric Surgery International, 2008
Background Laparoscopic appendicectomy is increasingly used in children. This national retrospective study compared outcomes of paediatric open and laparoscopic appendicectomy. Methods Length of stay, readmission rates and mortality in children undergoing open and laparoscopic appendicectomy in English NHS Trusts between 1 April 1996 and 31 March 2006 were compared. Procedures coded as emergency excision of appendix (OPCS-4 H01) on the Hospital Episode Statistics (HES) database in patients less than 15 years of age were included. Multivariate analysis was used to identify independent predictors of length of hospital stay and mortality.
Outcomes for open and laparoscopic appendicectomy for complicated appendicitis in children
South African Journal of Surgery
Background: The study aimed to compare the outcomes of paediatric laparoscopic appendectomy (LA) with open appendectomy (OA) for complicated appendicitis (CA). All trainees could perform OA without supervision. Methods: This is a single-centre, retrospective, non-randomised review of children 4-12 years of age, who had either an OA or LA for CA. The data was collected from August 2012 to June 2016. Nineteen surgical trainees were initially supervised by a consultant until deemed able to perform LA safely. The on-call surgeon decided on operative approach. Intra-and postoperative complications were analysed. Primary endpoint was comparison of infection rates between groups, simultaneous differences between the two procedures performed by surgical trainees and consultants were evaluated. Results: One hundred and fifty-five patients had appendicectomy for CA during the study period. Fourteen patients with incomplete information were excluded. Ninety had OAs and 51 LAs. Both groups were well matched demographically. Postoperative infective complications occurred in 13/51 (25.5%) of the LAs, and in 23/90 (25.6%) of the OA (p = 0.159). Fourteen trainees performed 27 LAs without consultant supervision by the conclusion of the study. The mean duration of LA surgery for surgical trainees was 110.35 minutes (IQR 22.5) and for consultants 93.87 minutes (IQR 35, p = 0.497). Conclusion: There is no difference in intra-and postoperative complications between LA and OA for CA. Duration of surgery between surgical trainees and consultants were comparable. This indicates that surgical trainees acquire LA skill over a short period of time and that LA as a laparoscopic teaching procedure merits consideration.
Laparoscopic Versus Open Appendectomy in Children
Annals of Surgery, 2006
This was a meta-analysis comparing laparoscopic and open appendectomy in a paediatric population. It concluded that laparoscopic appendectomy can reduce post-operative complications such as wound infection and ileus. The methodology was generally appropriate, although the lack of a quality assessment and the pooling of different study designs mean that the pooled results may not be reliable. Authors' objectives To use meta-analysis to compare laparoscopic and open appendectomy (LA and OA, respectively) in a paediatric population. Searching EMBASE, MEDLINE, and the Cochrane Library were searched for studies published between 1992 and 2004; the search terms were reported. The 'related articles' function was used to widen the search, with all abstracts, studies and citations being reviewed. Study selection Study designs of evaluations included in the review Comparative studies of LA and OA were eligible. The included studies were of a prospective randomised design, a prospective non-randomised design, or a retrospective design. Specific interventions included in the review Eligible interventions were LA and OA procedures. Variations on standard laparoscopic procedures, such as hybrid procedures (laparoscopic-assisted) or single trochar techniques, were excluded. The conversion rate from laparoscopic to open was reported by approximately half of the studies: it ranged from 0 to 25.9%. Participants included in the review Eligible studies were those of paediatric populations or which described the study group as children. The participants were aged from 0 to 20 years; 2 studies contained participants who were over 18 years old, but the studies were still included as their populations were described as 'children'. The percentage of patients with severe appendicitis (gangrene, perforation and abscess) varied between studies, from 12.9 to 100% for open procedures and from 0 to 100% for laparoscopic procedures; 6 studies matched OA and LA groups for appendicitis severity. Participants were matched for one or more of the following characteristics in 14 studies: age, weight, gender, peritonitis, fever, duration of illness and raised white cell count. Outcomes assessed in the review Eligible outcomes were post-operative complications such as post-operative fever, post-operative ileus, wound infection and intra-abdominal abscess formation, as well as operative time and length of post-operative hospital stay. Studies that did not report the standard deviation for the means of continuous outcomes were excluded.