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Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open
Kuo Jen Tsao1, Shawn D St Peter, Patricia A Valusek
1Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
The risk of adhesive small bowel obstruction (SBO) after pediatric appendectomy is low. Laparoscopic appendectomy (LA) demonstrated a statistically lower incidence of SBO compared to open appendectomy (OA), especially in perforated cases.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Complications
Background:
- Adhesive small bowel obstruction (SBO) is a frequent complication following abdominal surgery.
- Existing pediatric literature on SBO incidence and procedural risk is limited.
- The relationship between specific surgical procedures and SBO risk requires further elucidation.
Purpose of the Study:
- To determine the incidence of SBO after appendectomy in children.
- To compare the risk of SBO following laparoscopic appendectomy (LA) versus open appendectomy (OA).
- To assess the association between perforated appendicitis and SBO development.
Main Methods:
- Retrospective review of pediatric patients who underwent appendectomy between January 1998 and June 2005.
- Identification and analysis of cases with post-appendectomy SBO.
- Statistical comparison of SBO incidence between LA and OA groups using chi-squared analysis with Yates correction.
Main Results:
- A total of 1105 appendectomies were performed (628 LA, 477 OA).
- The overall incidence of SBO post-appendectomy was 0.7%.
- SBO occurred in 7 patients after OA (including 6 with perforated appendicitis) and 1 patient after LA (with perforated appendicitis), with a statistically significant lower incidence after LA (P = .01).
Conclusions:
- The overall risk of SBO after pediatric appendectomy is low and strongly associated with perforated appendicitis.
- Laparoscopic appendectomy is associated with a lower incidence of SBO compared to open appendectomy.
- Laparoscopic appendectomy is recommended as the preferred surgical approach for both perforated and non-perforated appendicitis in children.
Introduction:
Adhesive small bowel obstruction (SBO) is a common postoperative complication. Published data in the pediatric literature characterizing SBO are scant. Furthermore, the relationship between the risk of SBO for a given procedure is not well described. To evaluate these parameters, we reviewed the incidence of SBO after laparoscopic appendectomy (LA) and open appendectomy (OA) performed at our institution.
Methods:
With institutional review board approval, all patients that developed SBO after appendectomy for appendicitis from January 1998 to June 2005 were investigated. Hospital records were reviewed to identify the details of their postappendectomy SBO. The incidences of SBO after LA and OA were compared with chi2 analysis using Yates correction.
Results:
During the study period, 1105 appendectomies were performed: 477 OAs (8 converted to OA during laparoscopy) and 628 LAs. After OA, 7 (6 perforated appendicitis) patients later developed SBO of which 6 required adhesiolysis. In contrast, a patient with perforated appendicitis developed SBO after LA requiring adhesiolysis (P = .01). The mean time from appendectomy to the development of intestinal obstruction for the entire group was 46 +/- 32 days.
Conclusions:
The overall risk of SBO after appendectomy in children is low (0.7%) and is significantly related to perforated appendicitis. Small bowel obstruction after LA appears statistically less common than OA. Laparoscopic appendectomy remains our preferred approach for both perforated and nonperforated appendectomy.
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