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Open versus laparoscopic appendectomy in the pediatric population: a literature review and analysis of complications
Ciro Esposito1, Andres Ignacio Calvo, Marco Castagnetti
1Department of Pediatrics, Federico II University of Naples, Via Pansini 5, Naples, Italy. ciroespo@unina.it
Insights
Laparoscopic appendectomy (LA) offers advantages over open appendectomy (OA) in children, including fewer infections and faster recovery. While OA may be quicker for complex cases, LA is generally preferred for pediatric appendicitis treatment.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Appendicitis is a common surgical emergency in children.
- Laparoscopic appendectomy (LA) and open appendectomy (OA) are primary treatment options.
- Comparative outcomes, particularly complications, require detailed analysis in pediatric populations.
Purpose of the Study:
- To compare the efficacy and safety of laparoscopic appendectomy (LA) versus open appendectomy (OA) in pediatric patients.
- To analyze complication rates, operative time, and recovery metrics between LA and OA.
- To provide evidence-based recommendations for pediatric appendicitis management.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Medline, Cochrane, Embase, Sci Search, Lilacs, PubMed) for studies published between 1997 and 2010.
- Included were comparative studies of LA versus OA in pediatric populations (ages 0-18 years).
- Data extracted included operative time, hospital stay, postoperative complications, pain, and recovery.
Main Results:
- Analysis of 26 studies involving 123,628 children revealed LA was associated with lower surgical wound infection and postoperative ileus rates.
- Patients undergoing LA experienced reduced analgesic use, earlier diet resumption, shorter hospitalization, and quicker return to normal activities.
- No significant difference in intra-abdominal abscess formation was noted; OA showed reduced operative time for complicated appendicitis, while times were similar for simple cases.
Conclusions:
- Laparoscopic appendectomy (LA) demonstrates significant advantages over open appendectomy (OA) in the pediatric population.
- LA is associated with improved postoperative outcomes and faster recovery.
- Pediatric patients requiring appendectomy should be treated with LA, ideally in specialized centers.
Background:
This study aims to compare the results of laparoscopic and open appendectomy (LA and OA, respectively) in a pediatric population with particular attention to complications analysis.
Subjects And Methods:
A literature search was performed using Medline, Cochrane, Embase, Sci Search, Lilacs, and PubMed databases on all studies published during the 14-year interval of 1997-2010. Comparative studies of LA versus OA in the pediatric population were included in these studies. Data concerning operative time, length of hospital stay, postoperative complications, postoperative pain, and surgical trauma were recorded.
Results:
We recorded 52 studies, but 26 of these were excluded from our analysis because they were neither relevant nor related to the adolescent population. The 26 studies analyzed showed a population of 123,628 children and adolescents (ages 0-18 years) who underwent appendectomy by laparoscopic (LA, 42,213 [34.1%]) and open (OA, 81,415 [65.9%]) techniques. Our analysis showed that patients undergoing LA presented a lower incidence of surgical wound infection, lower incidence of postoperative ileus, a lower use of analgesics in the postoperative period, an earlier resumption of normal diet, a shorter hospitalization, and a more rapid recovery to resume normal activities compared with patients undergoing OA. This study, comparing LA versus OA in children, failed to identify any major difference between the two techniques in terms of formation of intra-abdominal abscesses. As for operative time, our analysis showed globally a significant reduced operative time in OA versus LA in complicated appendicitis, but in simple appendicitis the operative time seems to be the same.
Conclusions:
Our analysis of the literature showed that the LA technique presents several advantages compared with the OA technique. For this reason, if a child is hospitalized today for appendicitis treatment in a pediatric center where the laparoscopic approach is unavailable, he or she should be placed on antibiotics and transferred to a center that offers the laparoscopic approach.
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