Laparoscopic Appendectomy in Children: Preliminary Study in Pediatric Hospital Albert Royer, Dakar (original) (raw)
Related papers
Laparoscopic Appendectomy in Complicated Appendicitis of Children
Annals of Colorectal Research, 2014
Background: Laparoscopy is not an accepted procedure for complicated appendicitis in children for most pediatric surgeons. This procedure is associated with a higher incidence of postoperative abdominal abscess reported in some studies. Objectives: In this study, we investigated the security, efficacy and complications of laparoscopy in children with complicated appendicitis in Mofid Children's Hospital. Patients and Methods: From April 2010 to January 2013, we performed laparoscopic appendectomy (LA) in all cases of non-complicated and complicated appendicitis (including perforated appendicitis and localized or generalized peritonitis based on the operation findings and pathological reports). Primary outcomes were incidence of complications, intra-abdominal abscess and wound infection. Secondary outcomes were length of operation, length of hospital stay, resumption of diet, incidence of bowel obstruction, duration of antibiotic use and readmission. Laparoscopy appendectomy was performed with two working ports. Results: LA was performed in 123 children aged 2 to 14 years (mean of eight years) over a 3-year period, of whom only 34 cases had complicated appendicitis (either localized or generalized peritonitis). There was one conversion to open appendectomy (OA) in a patient with appendicular abscess with a mass, which excluded from our analysis. There were 6 patients with generalized peritonitis and 26 patients with localized abscess, and two patients with appendicular mass. The Average duration of symptoms was four days (ranged 3-6 days). The mean length of operation was 52 minutes (ranged 40-80 minutes). The average length of hospital stay was 4.4 days (ranged 4-7 days). They were able to restart oral intake from 16 to 48 hours postoperatively. Two patients (5%) had postoperative complications; one patient with intra-abdominal abscess who underwent reoperation and the second patient with umbilical wound infection was resolved with antibiotherapy. The average follow-up was 14 months (ranged from 4-36 months). Conclusions: We recommend laparoscopic approach for all children presenting complicated appendicitis as the initial procedure of choice.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2008
Materials and Methods: Between 1999 and 2005, 505 laparoscopic appendectomies were performed. In children aged between 2 and 18 years, number, sex, age, histologic type of appendicitis, additional surgical procedures, number and type of complications, time of procedure, and hospitalization were analyzed. Results: There was no need for conversion even in perforated appendicitis and in technically difficult cases. In 21 (4.16%) children in postoperative period minor complications occurred. Average operating time was 43 minutes. Average hospital stay was 2.4 days. Conclusions: Laparoscopic appendectomy is good alternative for classic appendectomy, irrespective of the degree of inflammation. Accurate cleaning and rinsing of the abdominal cavity essentially decreases the quantity of complications even in cases with perforated appendicitis. This suggests the expansion of indications toward laparoscopic appendectomy in case of all children with acute appendicitis.
Outcomes of Laparoscopic Appendectomy in Complicated Pediatric Appendicitis
International journal of scientific research, 2014
OBJECTIVES To assess the safety and efficacy of Laparoscopic appendectomy in complicated appendicitis in children. METHODS: All children admitted with diagnosis of acute appendicitis were evaluated. All children suspected to have complicated appendicitis are subjected to clinical examination and imaging. All children would be subjected to Laparoscopic appendectomy. RESULTS In our study it was seen that there was no incidence of post operative intra abdominal abscess. Lower incidence of post operative adhesions compared to open appendectomy. Lower incidence of infections, wound haematoma and post operative bowel paralysis when compared to open appendectomy. CONCLUSION Our results have indicated the feasibility, safety and efficacy of laparoscopic appendectomy in complicated appendicitis in children. The incidence of post-operative intra abdominal abcess was nil in our study probably due to the efforts taken to give a thorough peritoneal lavage and also an adequate course of higher an...
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.
Laparoscopic versus open appendectomy in children with complicated appendicitis
Annals of Pediatric Surgery, 2017
Patients and methods During the period from October 2012 to March 2016, 390 children with acute complicated appendicitis diagnosed clinically and with laboratory and available imaging studies were operated. LA performed for 200 cases and open conventional appendectomy for 190 cases. Three ports technique was used in laparoscopic cases. The operating table is shifted in Trendelenburg position and towards the left side. The surgeon stands on the left side of the patient. The appendicular mesoappendix was secured using electro cautery. The base was secured by extracorporeal ties and the appendix was retrieval within the umbilical port. The wounds were closed. Open appendectomy was done through McBurny incision as the traditional approach. Results A total of 390 children diagnosed with acute complicated appendicitis were operated. The mean age was 12.04 years in group A and 12.2 in group B. There were 260 were boys and 130 were girls. The mean operative time in the laparoscopic group was 56.4 min; while in the conventional group was 63.42 min. Conclusion LA was a suitable, effective and safe procedure in complicated cases that did not involve the base. It was associated with lower complications rate with all the advances of minimal invasive surgery when compared to the conventional open appendectomy. Ann
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...
2020
Transumbilical laparoscopic-assisted appendectomy (TULAA) is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis) and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA). All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA) was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males) with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years). Primary OA was performed in 144 cases. In 300 patients a tra...
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
Gastroenterology Research and Practice, 2015
Transumbilical laparoscopic-assisted appendectomy (TULAA) is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis) and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA). All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA) was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males) with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years). Primary OA was performed in 144 cases. In 300 patients a tra...