Complicated appendectomy in children in relation to laparoscopic vs open procedures

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• The efficacy of laparoscopic appendectomy for complicated appendicitis in children is debated, with some studies reporting higher rates of postoperative intraperitoneal abscess.
• Most existing research on laparoscopic appendectomy in pediatric populations originates from Western countries.

Purpose of the Study:

• To compare the outcomes of laparoscopic appendectomy versus open appendectomy in children diagnosed with complicated appendicitis.
• To evaluate the safety and effectiveness of laparoscopic appendectomy in a non-Western pediatric population.

Main Methods:

• A retrospective review was conducted at Chittagong Medical Hospital, Bangladesh.
• Intention-to-treat analysis compared 51 children undergoing laparoscopic appendectomy with 61 children undergoing open appendectomy.
• Data collected included operative time, wound infection rates, hospital stay, and incidence of postoperative complications such as abscess and fever.

Main Results:

• Laparoscopic appendectomy involved a longer mean operative time (112 vs. 72 minutes, p<0.005).
• Severe wound infection rates were significantly lower with laparoscopy (2.1% vs. 21%, p<0.05).
• Mean postoperative hospital stay was reduced for laparoscopic appendectomy (5.7 vs. 7.4 days, p<0.005), with no significant difference in the incidence of postoperative intraperitoneal abscess (12% vs. 11.5%) or fever.

Conclusions:

• Laparoscopic appendectomy is a safe and effective treatment for complicated appendicitis in children, associated with reduced wound infections and shorter hospital stays.
• The procedure does not appear to increase the risk of postoperative intraperitoneal abscess compared to open surgery.
• Findings support the use of laparoscopic appendectomy in pediatric patients, even in resource-limited settings.