The safety of laparoscopic appendectomy in complicated appendicitis in children

Authors

  • khawar abbas Senior Medical Officer, Pediatric Surgery Department, Shifa International Hospital Islamabad
  • Inayat ur Rehman Pediatric Surgery Department, Shifa International Hospital Islamabad
  • Anwar ul Haq Consultant Pediatric Surgeon, Shifa International Hospital Islamabad

DOI:

https://doi.org/10.46831/jpas.v2i2.132

Keywords:

Laparoscopic appendectomy, Open appendectomy, Postoperative complications, Complicated appendicitis

Abstract

BACKGROUND: Laparoscopic Appendectomy (LA) is no longer a new procedure in pediatric surgery. In many pediatric surgery centers, laparoscopic management of acute appendicitis is practiced but we have observed that most of them performed laparoscopic appendectomy for simple straight forward appendicitis. It is generally considered that complicated appendicitis is better managed by an open procedure. The objective of this study was to establish safety of laparoscopic appendectomy in complicated appendicitis in children.

METHODS: Research was conducted at the Department of Pediatric Surgery, Shifa International Hospital Islamabad. Duration of study was 3 years after due approval from the ethical and research review board. Medical records of 42 patients who were operated on for complicated appendicitis laparoscopically at Shifa International Hospital, Islamabad from January 2018 to December 2020 was reviewed. All patients were enrolled from the emergency department. Clinical assessment of the patients was done in a routine way by history and physical examination. Investigations included complete blood count, C reactive protein and ultrasound abdomen and pelvis. Patients who had simple uncomplicated appendicitis, who had open appendectomy, and those who had laparotomy for other reasons were excluded from the study. All those patients who had complicated appendicitis like perforation, abscess, mass, or gangrene were included in the study. Variables observed in this study were age, gender, operative findings, operative time, hospital stay and postoperative complications.

RESULTS: The mean age of the patients was 9.95 ±3.22 years. Of 42 patients, 32 (76%) patients were male and 10 (24%) were female. Mean operative time was 42.5 ±20.03 minutes. Mean hospital stay was 2.23 ±1.55 days. Out of 42 patients, 20 (48%) had perforated appendicitis, 9 (21%) patients had appendicular mass, 12 (29%) patients had appendicular abscess, and 1 (2%) patient had gangrenous appendicitis. Postoperatively, one patient of perforated appendicitis had trocar site infection. One patient who had appendicular mass developed urinary retention with periorbital puffiness postoperatively. Two patients of appendicular mass had transaction of appendicular base due to perforated and sloughed appendicular base. One patient with an appendicular abscess had a large collection in the right paracolic gutter. One patient of appendicular abscess developed peritonitis with abscess formation secondary to cecal perforation.

CONCLUSION: Laparoscopy for complicated appendicitis is safe in children with only fewer complications. Despite our limited experience of laparoscopic appendectomy, we believe that laparoscopy may safely be done as a first choice in all patients with appendicitis, whether simple or complicated.

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References

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990; 132:910–25.

Semm K. Endoscopic appendectomy. Endoscopy. 1983; 15:59–64.

Cox MR, McCall J, Toouli J, Padbury R, Wilson T, Wattchow D, et al. A prospective randomized comparison of open versus laparoscopic appendectomy in men. World J Surg. 1996; 20:263–6.

Mutter D, Vix M, Bui A, Evrard S, Tassetti V, Breton J, et al. Laparoscopy not recommended for routine appendectomy in men: Results of a prospective randomized study. Surgery. 1996; 120:71–4.

Williams MD, Collins JN, Wright TF, Fenoglio ME. Laparoscopic versus open appendectomy. South Med J. 1996; 89:668–74.

Laine S, Rantala A, Gullichsen R, Ovaska J. Laparoscopic appendectomy-is it worthwhile? Surg Endosc. 1997; 11:95–7.

Reiertsen O, Larsen S, Trondsen E, Edwin B, Faerden AE, Rosseland AR. Randomized controlled trial with sequential design of laparoscopic versus conventional appendectomy. Br J Surg. 1997; 84:842–7.

Garg CP, Vaidya BB, Chengalath MM. Efficacy of laparoscopy in complicated appendicitis. Int J Surg. 2009; 7:250–2.

Dai L, Shuai J. Laparoscopic vs open appendectomy in adults and children: a meta-analysis of randomized controlled trials. United Eur Gastroenterol J 2017; 5:542–53.

Seqsaqa, M., Rozeik, A.E., Khalifa, M. et al. Laparoscopic versus open appendectomy in complicated appendicitis in children: a single center study. Egypt Pediatric Association Gaz 68, 26 (2020).

Xiaolin Wang, Wen Zhang, Xiaojin Yang, Jinfan Shao, Xuefeng Zhou, Jiyan Yuan, Complicated appendicitis in children: is laparoscopic appendectomy appropriate? A comparative study with the open appendectomy—our experience, J of Ped Surg, 2009; 44; 10: 1924-7.

Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, et al. Laparoscopic versus open appendectomy: Outcomes comparison based on a large administrative database. Ann Surg. 2004; 239:43–52.

Chung R, Rowland DY, Li P, Diaz J. A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg. 1999; 177:250–6.

Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B. Meta-anal ysis of randomized controlled trials comparing laparoscopic and open ap pen dec tomy. Surg Laparosc Endosc. 1999; 9:17–26.

Temple LK, Litwin DE, McLeod RS. A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis. Can J Surg. 1999; 42:377–83.

Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: A meta-analysis. J Am Coll Surg. 1998; 186:545–53.

Kazemier G, Steyerberg EW, Bonjer HJ. Meta-analysis of randomized -clinical trials comparing open and laparoscopic appendectomy. Surg Endosc. 1997; 11:170.

Slim K, Pezet D, Chipponi J. Laparoscopic or open appendectomy. Critical review of randomized, controlled trials? Dis Colon Rectum. 1998; 41:398–403.

Sauerland S, Lefering R, Holthausen U, Neugebauer EA. Laparoscopic vs conventional appendectomy-a meta-analysis of randomized controlled trials. Langenbecks Arch Surg. 1998; 383:289–95.

Yau KK, Siu WT, Tang CN, Yang GP, Li MK. Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg. 2007; 205:60–5.

Lintula H, Kokki H, Vanamo K. Single-blind randomized clinical trial of -laparoscopic versus open appendicectomy in children. Br J Surg. 2001; 88:510–4.

Esposito C, Borzi P, Valla JS, Mekki M, Nouri A, Becmeur F, et al. Laparoscopic versus open appendectomy in children: A retrospective comparative study of 2,332 cases. World J Surg. 2007; 31:750–5.

Milewczyk M, Michalik M, Ciesielski M. A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. Surg Endosc. 2003; 17:1023–8.

Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults: A prospective study. Ann Surg. 1995; 221:278–81.

Krukowski ZH, Irwin ST, Denholm S, Mathewson NA. Preventing wound infection after appendectomy: A review. Br J Surg. 1998; 75:1023–33.

Reid RI, Dobbs BR, Frizelle FA. Risk factors for post-appendectomy intra-abdominal abscess. Aust N Z J Surg. 1999; 69:373–4.

Alvarez C, Voitk AJ. The road to ambulatory laparoscopic management of perforated appendicitis. Am J Surg. 2000; 179:63–6.

Krisher SL, Browne A, Dibbins A, et al. Intra-abdominal abscess after laparoscopic appendicectomy for perforated appendicitis. Arch Surg. 2001; 136:438–41.

Liu SI, Siewert B, Raptopoulos V, et al. Factors associated with conversion to laparotomy in patients undergoing laparoscopic appendicectomy. J Am Coll Surg. 2002; 194:298–305.

Rasuli SF, Naz J, Azizi N, Hussain N, Qureshi PNAA, Swarnakari KM, Dost W, Zafar S, Qadar LT, Talpur AS. Laparoscopic Versus Open Appendectomy for Patients with Perforated Appendicitis. Cureus. 2022 Jun 23;14(6).

Published

2023-09-23

How to Cite

1.
abbas khawar, Rehman I ur, Haq A ul. The safety of laparoscopic appendectomy in complicated appendicitis in children. J Pediatr Adolesc Surg [Internet]. 2023Sep.23 [cited 2024Apr.17];2(2). Available from: http://jpedas.org/ojs/index.php/jpedas/article/view/132
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