[Comparative study of surgical and endosurgical treatment of generalized appendicular peritonitis in children]

The aim of the study was to evaluate the efficacy of endosurgery for generalized appendiceal peritonitis in children. Laparoscopic appendectomy (LA) was used as a procedure of choice in all forms of peritonitis and its complications. Original three-trocar approach and modified Gotz technique were applied. From 1991 to 2002 LA was performed in 4024 children aged from 7 days to 16 years, in 298 (5.8%) patients generalized peritonitis was diagnosed current. Prospective comparative randomized study includes 200 patients with generalized appendicular peritonitis. Contraindications were in 7% cases, rate of conversion to open surgery--2.1%. Duration of surgery was 61.7 +/- 24 min in laparoscopic group (LG) vs 73.2 +/- 31 min in open surgery group (OG). Patients of LG demonstrated earlier repair of many functions. There were no lethal outcomes. Rate of minor surgical complications was 10% in LG and 21% in OG (p < 0.05), major complications--13 and 16% (p = 0.55), respectively. There was no difference in rate of abscess formation (4%). Rate of pneumonia was 1% in LG and 3% in OG (p < 0.05), rate of critical conditions--2 and 4% (p = 0.067). Hospital stay was 15.7 +/- 3.1 days in LG and 21.2 +/- 3.8 days in OG. It is concluded that laparoscopic approach could be successfully used in more than 90% cases of generalized appendicular peritonitis. Endosurgery has many advantages over open surgery. LA demonstrates the best benefits in generalized peritonitis.