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Prospective evaluation of a primary laparoscopic approach for children presenting with simple or complicated
1Department of Pediatric Surgery, The Children's Hospital, University of Colorado Health Sciences Center at Denver, 1056 East 19th Avenue, B-323, Denver, CO 80218, USA. Partrick.David@tchden.org <Partrick.David@tchden.org>
Insights
Laparoscopic appendectomy in children with appendicitis shows a low complication rate of 6%. This standardized approach does not increase the risk of postoperative intra-abdominal abscesses, even in complicated cases.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
Background:
- Previous studies suggested laparoscopy increases abscess risk in complicated appendicitis.
- This study evaluates a standardized laparoscopic approach for pediatric appendicitis.
Purpose of the Study:
- To prospectively evaluate a standardized laparoscopic approach for all pediatric appendicitis cases.
- To determine the postoperative outcomes and complication rates.
Main Methods:
- A 5-year prospective study (2001-2005) of laparoscopic appendectomies in children.
- Standardized approach by a single surgeon for simple and complicated appendicitis.
- Recording of preoperative, intraoperative, and postoperative data.
Main Results:
- 175 laparoscopic appendectomies performed with zero open conversions.
- Overall complication rate was 6% (abscess/phlegmon in 9, wound infections in 2).
- Mean patient age was 9 years; 38% had complicated appendicitis.
Conclusions:
- A laparoscopic approach for all pediatric appendicitis cases does not increase complication rates.
- Infectious complications occurred in only 6% of patients undergoing laparoscopic appendectomy.
- Standardized laparoscopic appendectomy is a safe and effective primary technique.
Background:
Previous studies have suggested laparoscopy leads to an increased risk of postoperative intra-abdominal abscess formation in complicated appendicitis. The purpose of this study is to prospectively evaluate a standardized laparoscopic approach applied by a single surgeon for all children who present with appendicitis and to determine the postoperative outcome.
Methods:
Over a 5-year period (2001-2005), all children presenting to the author with simple or complicated appendicitis were approached laparoscopically and their preoperative workup, intraoperative findings, and postoperative outcomes recorded.
Results:
One hundred seventy-five consecutive laparoscopic appendectomies were performed with no open conversions. Mean patient age was 9 years. Sixty-seven patients (38%) presented with complicated appendicitis. The overall complication rate was 6% (9 children developed a postoperative intra-abdominal abscess or phlegmon and 2 had umbilical wound infections).
Conclusions:
When laparoscopic appendectomy is used as the primary technique, only 6% of patients experience infectious complications. Therefore, a laparoscopic approach to all children presenting with appendicitis does not lead to an increased complication rate.
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