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Laparoscopic versus Open Surgery in Complicated Appendicitis in Children Less Than 5 Years Old: A Six-Year
R Guanà1, L Lonati1, S Garofalo1
1Division of Pediatric General, Thoracic & Minimally Invasive Surgery, AOU Città della Salute e della Scienza, Regina Margherita Children's Hospital, Turin, Italy.
Insights
Laparoscopic surgery is superior for treating complicated appendicitis in children under five. This approach significantly reduces postoperative complications compared to traditional open surgery.
Area of Science:
- Pediatric Surgery
- Surgical Emergencies
Background:
- Acute appendicitis is the most frequent surgical emergency in children.
- Appendicitis is uncommon in children under 5 years old.
- Laparoscopic appendectomy is optimal for complicated appendicitis but challenging in very young children.
Purpose of the Study:
- To compare the outcomes of laparoscopic versus open appendectomy for complicated appendicitis in children under 5 years of age.
Main Methods:
- A retrospective review of 525 acute appendicitis cases from January 2009 to December 2015.
- Focus on 120 patients under 5 years old with complicated appendicitis (peritonitis).
- Comparison of postoperative complication rates between open and laparoscopic surgical approaches.
Main Results:
- Of 90 children with complicated appendicitis, 43 underwent open surgery and 47 underwent laparoscopy.
- Postoperative complication rates were significantly higher in the open surgery group (63%) compared to the laparoscopic group (26%).
- Severe complications requiring reintervention were predominantly associated with open surgery.
Conclusions:
- Laparoscopic surgery is the preferred approach for complicated appendicitis in children under 5.
- Laparoscopic appendectomy leads to fewer and less severe postoperative complications than open appendectomy in this age group.
Abstract:
Introduction. Acute appendicitis is the most common surgical emergency in the pediatric population. The peak incidence occurs in the first decade of life, while it is uncommon to face appendicitis in children younger than 5 years of age. Laparoscopy is now demonstrated to be the optimal approach also to treat complicated appendicitis, but in very young children this standardized operation is not always easy to perform. Material and Methods. From January 2009 to December 2015 we operated on 525 acute appendicitis, with 120 patients less than 5 years of age. Results. 90 children had a complicated appendicitis (localized or diffuse peritonitis): 43 (48%) were operated on by open approach and 47 (52%) by laparoscopy. The overall incidence of postoperative complications was greater in the open appendectomy group (63% versus 26%) and all severe complications requiring reintervention (6% of cases: 3 postoperative abscesses resolved with ultrasound guided percutaneous abscess drainage; 1 tubal surgery for salpingitis; 1 adhesion-related ileus requiring relaparotomy) were mostly associated with open surgery. Conclusions. Laparoscopic surgery resulted as the best approach for treating complicated appendicitis also in younger children, with minor and less severe postoperative complications compared to open surgery.
