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Laparoscopic versus open appendicectomy in children: a UK District General Hospital experience
Hussamuddin Adwan1, Chathika K Weerasuriya1, Phillip Endleman1
1West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, Suffolk, UK.
Insights
Laparoscopic appendicectomy in children significantly reduces post-operative morbidity compared to open surgery. This UK study found fewer complications like intra-abdominal collections with the laparoscopic approach, though length of stay was similar.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Appendicitis is a common surgical emergency in children.
- Traditional open appendicectomy (OA) carries risks of post-operative complications.
- Laparoscopic appendicectomy (LA) is an alternative minimally invasive approach.
Purpose of the Study:
- To compare the effectiveness of laparoscopic appendicectomy versus open appendicectomy in reducing morbidity and length of stay in pediatric patients.
- To evaluate outcomes in a UK District General Hospital setting.
Main Methods:
- A retrospective review of 80 children (≤ 15 years) who underwent appendicectomy over three years.
- Data included complication rates (wound infection, intra-abdominal collection, ileus) and length of stay (LOS).
- Statistical analysis used Chi-square and Mann-Whitney tests.
Main Results:
- Laparoscopic appendicectomy (n=27) showed significantly lower collective morbidity (3.8%) compared to open appendicectomy (n=53) (25.9%).
- Specific reductions in intra-abdominal collections were observed with LA (1.9% vs. 14.8%).
- Median length of stay was similar between groups (1 day for LA vs. 2 days for OA).
Conclusions:
- Laparoscopic appendicectomy is a safe and effective procedure for children in a District General Hospital.
- LA is associated with significantly reduced post-operative morbidity compared to the open technique.
Aims:
The aim of this study was to evaluate the potential role of laparoscopic appendicectomy in reducing morbidity and length of stay in children compared to open procedures in a UK District General Hospital setting.
Methods:
A three-year retrospective review of children ≤ 15 years with histologically confirmed appendicitis who underwent laparoscopic (LA) and/or open (OA) appendicectomy was performed. Choice of operation was based on individual surgeon's preference and on patient's body size. Data collected included rate of histologically complicated appendicitis, post-operative length of stay (LOS), and collective and differential morbidity rates, i.e., wound infection, intra-abdominal collection, and ileus. Chi-square and Mann-Whitney tests were used for statistical analysis. P<0.05 was regarded as significant.
Results:
Eighty children (70% male) were identified at median age 11 (3-15) years. They could be divided into complicated (n=18, 22%) and simple appendicitis (n=62, 78%). Appendicectomy was performed in all as an OPEN (n=53, 66%) or LAPAROSCOPIC (n=27, 34%) procedure. Both groups were comparable in gender distribution (P=0.11) and rate of complicated appendicitis (30% vs. 19%, respectively; P=0.27). Median age was significantly lower in the OPEN group [10 (3-15) vs. 12 (7-15) years; P<0.004]. Laparoscopic appendicectomy had a significantly lower rate of collective morbidity (3.8% vs. 25.9%; P<0.003), including lower rate of intra-abdominal collection (1.9% vs. 14.8%; P<0.01). Median LOS was not significantly different (1 day vs. 2 days; P=0.14).
Conclusion:
Laparoscopic appendicectomy in children in a UK District General Hospital is safe and was associated with significantly less post-operative morbidity than the open technique.
