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Comparison of intraabdominal abscess formation after laparoscopic and open appendicectomies in children
Ramesh M Nataraja1, Warwick J Teague, Julie Galea
1Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK. nataraja@doctors.org.uk
Insights
Laparoscopic appendicectomy (LA) and open appendicectomy (OA) have similar rates of intra-abdominal abscesses (IAAs). Complicated appendicitis increases IAA risk regardless of the surgical technique used.
Area of Science:
- Pediatric surgery
- Surgical outcomes
- Infectious complications
Background:
- Laparoscopic appendicectomy (LA) is an alternative to open appendicectomy (OA).
- Concerns exist regarding a potentially higher incidence of intra-abdominal abscesses (IAAs) after LA.
- This study investigates IAA rates in pediatric patients undergoing both procedures.
Purpose of the Study:
- To compare the incidence of intra-abdominal abscesses (IAAs) between laparoscopic appendicectomy (LA) and open appendicectomy (OA) in pediatric surgical centers.
- To identify factors associated with IAA formation in pediatric appendicectomy patients.
Main Methods:
- Retrospective analysis of pediatric patients undergoing LA or OA over an 8-year period.
- Data collected included IAA formation, appendicitis complexity, diagnostic investigations, surgeon grade, and wound infection rates.
- Statistical analysis was performed to compare outcomes between the two surgical techniques.
Main Results:
- No significant difference in IAA incidence was observed between LA (3.9%) and OA (3.9%).
- Complicated appendicitis significantly increased the risk of IAA (9.1% vs 1.6%).
- A higher proportion of complicated appendicitis cases were observed in the LA group (37.1% vs 27.0%).
Conclusions:
- Appendicectomy technique (LA vs OA) does not influence the incidence of intra-abdominal abscesses.
- Complicated appendicitis is the primary risk factor for developing IAAs, irrespective of the surgical approach.
- The findings support LA as a safe alternative to OA in pediatric appendicectomy.
Aim:
Although laparoscopic appendicectomy (LA) is an accepted alternative to the open appendicectomy (OA) approach, it has been suggested that there is a higher incidence of intraabdominal abscesses (IAAs). Our aim was to determine the incidence of IAA in 3 pediatric surgical centers routinely practicing both techniques.
Methods:
Data were collected retrospectively for pediatric patients undergoing LA or OA over an 8-year period. Analysis included IAA formation, appendicitis complexity, radiologic/histologic investigations, grade of surgeon, and wound infection.
Main Results:
A total of 1267 appendicectomies were performed (514 LAs and 753 OAs). There was no difference between the incidences of IAA (LA, 3.9% [19/491] vs OA, 3.9% [28/714]; P = 1.0). The incidence of IAA was increased in those with complicated appendicitis (34/375 [9.1%] vs 13/830 [1.6%]; P ≤ .0001). There was an increased proportion of those with complicated appendicitis in the LA group (182/491 [37.1%] vs 193/714 [27.0%]; P = .0002). Surgical trainees were more likely to be the primary surgeon in the OA group (79% vs 63%; P = .0001), although the incidence of IAA did not correlate with grade of surgeon. There was no significant difference in incidence of wound infection between groups (LA, 4.6% [8/173] vs OA, 2.5% [18/377]; P = .93).
Conclusion:
This large retrospective study shows that the technique of appendicectomy does not appear to affect the incidence of IAAs. Patients with complicated appendicitis are more likely to develop an IAA regardless of technique.
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