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Published on: February 28, 2025
Open and laparoscopic appendectomy are equally safe and acceptable in children
T Oka1, A G Kurkchubasche, J G Bussey
1Department of Pediatric Surgery, Hasbro Children's Hospital and Brown Medical School, 2 Dudley Street, Providence, RI 02905, USA.
Insights
Laparoscopic appendectomy (LA) is a safe and feasible option for pediatric appendicitis, showing comparable complication rates to open appendectomy (OA). While not statistically significant, a slightly higher abscess rate was observed in perforated cases undergoing laparoscopy.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Acute appendicitis is common in children.
- Surgical options include laparoscopic appendectomy (LA) and open appendectomy (OA).
- Comparative safety and feasibility data are crucial for treatment decisions.
Purpose of the Study:
- To prospectively compare the safety and feasibility of laparoscopic appendectomy (LA) versus open appendectomy (OA) in pediatric patients.
- To evaluate complication rates and outcomes between the two surgical approaches.
Main Methods:
- Randomized controlled trial involving 517 children with acute appendicitis.
- Patients were assigned to LA or OA based on surgeon availability.
- Data collected included demographics, operative time, length of stay, and postoperative complications.
Main Results:
- 376 open appendectomies (OA) and 141 laparoscopic appendectomies (LA) were performed.
- Demographics and perforated appendicitis rates were similar between groups.
- Overall complication rates were 11.2% for OA and 9.9% for LA, with similar operative times.
Conclusions:
- Laparoscopic appendectomy (LA) is a safe and feasible treatment for pediatric appendicitis.
- LA does not increase the risk of complications compared to open appendectomy (OA).
- A trend towards higher abscess rates in perforated appendicitis cases treated with LA was noted but was not statistically significant.
Background:
The aim of this study was to evaluate prospectively whether laparoscopic (LA) and open appendectomy (OA) are equally safe and feasible in the treatment of pediatric appendicitis.
Methods:
A total of 517 children with acute appendicitis were randomly assigned to undergo LA or OA appendectomy, based on the schedule of the attending surgeon on call. Patient age, sex, postoperative diagnosis, operating time, level of training of surgical resident, length of postoperative hospitalization, and minor and major postoperative complications were recorded. Chi-square analysis and the Student t-test were used for statistical analysis.
Results:
In all, 376 OA and 141 LA were performed. The two groups were comparable in terms of patient demographics and the incidence of perforated appendicitis. The operative time was also similar (47.3 +/- 19.7 vs 49.9 +/- 12.9 min). The overall incidence of minor or major complications was 11.2% in the OA group and 9.9% in the LA group.
Conclusion:
Pediatric patients with appendicitis can safely be offered laparoscopic appendectomy without incurring a greater risk for complications. Nevertheless, a higher (but not significantly higher) abscess rate was found in patients with perforated appendicitis who underwent laparoscopy.
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