[Laparoscopic appendectomy in pediatric patients: experience of 2300 operations]

The experience of 2300 laparoscopic appendectomies in children aged between 7 days and 14 years is presented. Uncomplicated forms of acute appendicitis were observed in 1611 patients (70.1%). Complicated forms were observed in 689 (29.9%) patients: general peritonitis in 196, local peritonitis--in 334, periappendicular abscess--in 122 and friable infiltrate--in 37 patients. Laparoscopic appendectomy according to F. Götz modified and adapted by us to children's age was used for all variants of the appendix location, including atypical. Optimal surgical approaches for children of early age and children over 3 years were developed. All laparoscopic interventions were completed endosurgically. Only in 15 (0.65%) patients the transition to open surgical operation was carried out on a diagnostic phase of the laparoscopic appendectomy for contraindications (solid infiltration, general peritonitis with multiple abscesses, intestine paresis with need of decompression). On comparative estimation of the laparoscopic and traditional appendectomies the indisputable advantages of the endoscopic technique are proved: more smooth course of the postoperative period, reduction of complications' number, reduction of hospital stay. Laparoscopic appendectomy is the most effective technique for the treatment of acute appendicitis complicated forms. Mean operative time was 65 min (range 42-120 min). Total amount of the postoperative complications in this group decreased almost 3 times. Frequency of such serious intraabdominal complications as acute commissural ileus decreased 3.5 times, infiltrates and abscesses of the abdominal cavity--2 times. Suppuration of the anterior abdominal wall was extremely rare. Mean hospital stay reduced almost 2 times. Intraoperative complications and lethality was not observed.