Laparoscopic appendectomy: burden or benefit? A single-center experience

Although laparoscopic appendectomy (LA) is now a common practice, it has not yet become the standard of care because it has no clear advantage when compared to open appendectomy (OA), especially in cases of complicated appendicitis. Moreover, the literature reports an increased incidence of postoperative infections with LA.

To review our center's experience with LA and to compare it to the literature.

All LAs performed between January 2004 and October 2007 were retrospectively reviewed for age, gross operative findings, pathology reports, operating time, length of hospital stay (LOS), and the time to resume regular diet and reach afebrile status. All patients who presented with phlegmonous appendicitis were treated medically and had a secondary appendectomy.

A total of 151 children underwent LA during this period (60 girls, 91 boys); the mean age was 10.4 years (range, 4-16). Forty-five patients (29.8%) presented with perforated appendicitis (PA). Nine patients had normal appendix on pathology. The mean operative time was 58.7 minutes (56.1 minutes for simple appendicitis [SA] and 64.8 minutes for PA). The mean intravenous narcotic analgesia duration was 12.2 hours for SA and 15.1 hours for PA. LOS was 2.82 days for SA and 3.8 days for PA. Regular diet was tolerated 1.47 days postoperatively for SA and 2.4 days for PA. The latter patients remained febrile for an average of 1.9 days. None of the patients presented with intra-abdominal infection postoperatively. Seven patients (4.6%) presented a trocar site infection. Since the introduction of a routine LA in 2004, the operating room time decreased from 66.4 minutes to 51 minutes.

This series confirms the safety of LA in almost all cases. The absence of intra-abdominal infections and the low rate of wound infections noted with LA compare favorably with the open approach. This approach is not only advantageous for cosmesis but also allows satisfying parents' requests, helps developing surgeons' laparoscopic skills, and is cost-effective.