Laparoscopic appendectomy in children: report of 465 cases

The authors present a retrospective analysis of 465 pediatric laparoscopic appendectomies. The ages of these patients ranged from 3 to 16 years, with a mean age of 10 years. The diagnosis of acute appendicitis was based on one or more of the following: the initial or repeated physical examination, abdominal radiographs, leukocyte blood count, and ultrasonography. On gross examination, 90% of appendices appeared inflamed, while on microscopic examination, 93% showed evidence of acute inflammation. There was a 3.6% incidence of minor intraoperative incidents and a 3.0% postoperative complication rate with 1.3% of patients requiring a subsequent laparotomy or repeat laparoscopic procedure. There were no deaths. The advantages of laparoscopic appendectomy include easy and rapid localization of the appendix, regardless of its location, the ability to explore the entire abdominal cavity through the same laparoscopic portals used for appendix removal, the ability to lavage completely the contaminated peritoneal cavity, a reduction in the incidence of intraperitoneal abscesses, and a probable reduction in postoperative adhesions. In addition, laparoscopic appendectomy is associated with less cutaneous scarring and a more rapid return of intestinal function and normal activities. In our experience, these results are better than those obtained with classical surgery.