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Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach
Published on: August 8, 2025
601
Is the laparoscopic approach appropriate for pediatric subhepatic appendicitis?
Belén Aneiros Castro1, Indalecio Cano Novillo1, Araceli García Vázquez1
1Department of Pediatric Surgery, 12 October Hospital, Madrid, Spain.
Asian Journal of Endoscopic Surgery
|February 20, 2018
Summary
Laparoscopic surgery for subhepatic appendicitis in children is safe, with similar complication rates to non-subhepatic cases. However, this unusual appendix location presents higher rates of complicated appendicitis and technical challenges.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Gastrointestinal Surgery
Background:
- Subhepatic appendicitis is a rare pediatric condition posing surgical challenges.
- Laparoscopic appendectomy is a common procedure for appendicitis.
Purpose of the Study:
- To compare outcomes of laparoscopic appendectomies based on appendix location.
- To evaluate the safety and feasibility of laparoscopic subhepatic appendectomy in children.
Main Methods:
- Retrospective review of 1736 pediatric laparoscopic appendectomies.
- Comparison between subhepatic (n=56) and non-subhepatic (n=1680) appendix locations.
- Statistical analysis with P < 0.05 considered significant.
Main Results:
- Subhepatic appendicitis cases showed higher rates of gangrenous (44.6%) or perforated (16.1%) disease compared to non-subhepatic (phlegmonous 56.9%).
- The subhepatic group experienced more technical difficulties (1.6%), required abdominal drains (18.6%), and had longer operative times and hospital stays.
- Intraoperative and postoperative complication rates were comparable between the two groups.
Conclusions:
- Laparoscopic subhepatic appendectomy is a safe procedure in children, not associated with increased complications.
- The atypical subhepatic location increases the likelihood of complicated appendicitis and presents technical challenges during surgery.
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