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Laparoscopic appendicectomy for complicated appendicitis in children
1Paediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia. thambidorai@gmail.com
Singapore Medical Journal
|January 6, 2009
Summary
Laparoscopic appendicectomy in children with complicated appendicitis resulted in longer operative times but significantly lower wound infection rates and shorter hospital stays compared to open surgery. The risk of abscess was similar between the two procedures.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- The efficacy of laparoscopic appendicectomy for complicated appendicitis in children is debated, with concerns about higher rates of postoperative intraperitoneal abscess.
- Most existing research on laparoscopic appendicectomy in pediatric populations originates from Western countries.
Purpose of the Study:
- To compare the outcomes of laparoscopic appendicectomy versus open appendicectomy in children diagnosed with complicated appendicitis.
- To evaluate the safety and effectiveness of laparoscopic appendicectomy in a Malaysian hospital setting.
Main Methods:
- A retrospective review comparing laparoscopic appendicectomy (performed by a single surgeon) with open appendicectomy (performed by surgical trainees).
- Standard surgical techniques were employed for both procedures without case selection for laparoscopy.
- Key outcomes analyzed included operative time, duration of hospital stay, wound infection rates, incidence of intraperitoneal abscess, and postoperative fever.
Main Results:
- Laparoscopic appendicectomy involved a longer mean operative time (112 vs. 72 minutes) but significantly reduced severe wound infection rates (2.1% vs. 21%) and mean postoperative hospital stay (5.7 vs. 7.4 days).
- The incidence of postoperative intraperitoneal abscess (12% vs. 11.5%) and postoperative fever (20% vs. 11.5%) were not significantly different between the laparoscopic and open groups.
- Six cases required conversion from laparoscopy to an open procedure.
Conclusions:
- Laparoscopic appendicectomy in children with complicated appendicitis is associated with a lower incidence of wound infection and a shorter postoperative hospital stay.
- The study found no increased risk of postoperative intraperitoneal abscess with laparoscopic appendicectomy compared to open surgery.
- These findings support the use of laparoscopic appendicectomy in this pediatric population, despite longer operative times.
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