Open versus laparoscopic treatment for pan-peritonitis secondary to perforated appendicitis in children: a...

Reports on laparoscopic treatment (LT) of peritonitis secondary to perforated appendicitis (PA) in children often include localized peritonitis/appendiceal mass, without specifically referring to pan-peritonitis (PP). This study compared LT with open treatment (OT) in only those patients with PP secondary to PA.

PP was defined as generalized abdominal rigidity on presentation with purulent material intraoperatively found throughout the entire abdominal cavity. Based on this definition, we identified 23 cases of PP secondary to PA from all our cases of appendicitis from 2004 to 2008 and prospectively collected data.

Surgical intervention was LT in 12 cases and OT in 11 cases. Appendectomy was successful in all cases without intraoperative complications. Mean age at surgery, sex ratio, preoperative mean white blood cell count, and C-reactive protein were similar. Mean operative time was 119 minutes for LT and 107 minutes for OT (P = NS). Mean volume of saline used for peritoneal lavage was 2730 mL for LT and 2950 mL for OT (P = NS). Duration of analgesic usage was significantly shorter in LT (P = 0.01). Postoperative wound infections were significantly less in LT (P = 0.04: LT 0, OT 4/11). Adhesive bowel obstruction occurred in one LT case and three OT cases (P = NS); none required surgery. There were two cases of intraabdominal abscess in each group, all were conservatively treated. Time taken to become afebrile, for white blood cell count and C-reactive protein to normalize, for intravenous antibiotics to be ceased, and for oral feeding to be commenced were not significantly different. Mean hospitalization was significantly shorter for LT (P = 0.04).

LT would appear to be superior for the treatment of PP secondary to appendicitis in children and would even seriously consider it as the procedure of choice.