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Laparoscopic versus open appendectomy in the management of acute appendicitis in children: a multicenter
G Scirè1, A Mariotto, M Peretti
1Pediatric Surgery Unit, Department of Surgery University of Verona, Verona, Italy - luca.giacomello@univr.it>
Insights
Laparoscopic appendectomy (LA), transumbilical laparoscopically assisted appendectomy (TULAA), and open appendectomy (OA) are equally safe for children with appendicitis. While OA is faster, TULAA offers shorter hospital stays, but with a higher wound infection rate.
Area of Science:
- Pediatric Surgery
- Surgical Techniques
- Acute Appendicitis Management
Background:
- Open appendectomy (OA) is the traditional standard for pediatric appendicitis.
- Minimally invasive options like laparoscopic appendectomy (LA) and transumbilical laparoscopically assisted appendectomy (TULAA) have emerged.
- Clinical consensus on the benefits of newer techniques in children remains unclear.
Purpose of the Study:
- To compare outcomes of OA, LA, and TULAA in pediatric patients.
- Evaluate safety and efficacy of different appendectomy approaches in children.
- Provide data to inform surgical decision-making for pediatric appendicitis.
Main Methods:
- Retrospective analysis of 196 pediatric patients with acute appendicitis.
- Comparison of operative time, length of hospitalization (LOH), and complication rates.
- Data collected from pediatric surgery and general surgery departments.
Main Results:
- Operative time was shortest for OA.
- No significant difference in overall intra- and postoperative complications between LA, TULAA, and OA.
- TULAA group had a shorter LOH but a higher incidence of wound infection.
Conclusions:
- LA, TULAA, and OA are comparable and safe surgical options for pediatric appendicitis.
- TULAA may reduce length of hospitalization but warrants attention to wound infection rates.
- Further randomized controlled trials are needed to solidify evidence.
Aim:
Acute appendicitis is one of the most common indications for emergency surgery in children. Open appendectomy (OA) has been the gold standard treatment for over 100 years. In the last three decades, the introduction of minimally invasive techniques, such as laparoscopic appendectomy (LA) and transumbilical laparoscopically assisted appendectomy (TULAA), has changed the approach to the disease. However, there is still no agreement with benefits of these new therapeutic options, especially in children. The aim of this retrospective study is comparing the outcomes of OA, LA and TULAA in the paediatric patient.
Methods:
Children suffering from acute appendicitis were treated with LA or TULAA in the Department of Paediatric Surgery and with OA in the Department of General Surgery. Data were abstracted from database of both centers' archives. Operator, operating time, length of hospitalization (LOH), intra- and postoperative complications and histological finding were analyzed.
Results:
We recruited 196 patients: 46 treated with LA, 62 with TULAA and 88 with OA. Operative time was significantly shorter in OA. The three techniques had the same incidence of intraoperative and postoperative complications. The incidence of wound infection was higher with the TULAA approach. LOH was significantly shorter in the TULAA group. There was no correlation between LOH and histological finding.
Conclusion:
We demonstrated that LA, TULAA and OA are similar in most respects and are equally safe modalities in paediatric patients. Further randomized controlled studies are necessary.
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