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Trends in the Use of Laparoscopic Versus Open Paediatric Appendicectomy: A Regional 12-Year Study and a National
N R Bhatt1, E Dunne1, M Faraz1
1Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
Insights
Laparoscopic appendicectomy (LA) is widely used for acute appendicitis in adults, but its adoption in children is less clear. This study found LA use in children has plateaued, with surgeons preferring open appendicectomy (OA) for younger patients despite evidence of LA benefits.
Area of Science:
- Pediatric Surgery
- Surgical Techniques
- Acute Appendicitis Management
Background:
- Laparoscopic appendicectomy (LA) is standard for adult appendicitis, but its role in pediatric patients remains debated.
- Investigating LA usage, trends, and complications in children compared to adults is crucial for optimizing pediatric appendicitis treatment.
Purpose of the Study:
- To evaluate the current utilization and trends of laparoscopic appendicectomy (LA) in pediatric appendicitis.
- To compare LA outcomes in children with contemporaneous adult controls.
- To assess the perceptions and practices of Irish surgeons regarding LA in pediatric patients.
Main Methods:
- A retrospective case-control study analyzed 5784 appendicectomy cases over 12 years, with a focus on 2960 pediatric patients (<16 years).
- Pediatric cases were stratified by age quartiles.
- A national survey of general and pediatric surgeons gathered data on their beliefs and practices regarding LA in children.
Main Results:
- The overall LA rate for pediatric appendicitis was 65%, showing a steady state after 2010.
- LA utilization increased with age and weight, with significantly higher rates in older children and adolescents (e.g., 93% in >16 years).
- A national survey revealed surgeons believed LA offered no advantage over open appendicectomy (OA) except for cosmetic reasons, favoring a case-by-case approach for younger children.
Conclusions:
- Laparoscopic appendicectomy use in Irish pediatric appendicitis is comparable to international rates but has not increased.
- Irish surgeons continue to favor open appendicectomy for younger children, preferring individualized treatment over routine LA.
- This practice persists despite regional and international evidence supporting favorable outcomes with LA in pediatric appendicitis.
Background:
In adult patients, it is generally accepted that laparoscopic appendicectomy (LA) is the predominant operative pathway in treating acute appendicitis. The case for a similar pathway utilising LA in children is less clear. We investigate usage, trends and complications after LA in children in a single co-located adult/paediatric centre with contemporaneous adults as controls.
Methods:
A retrospective case-control study was conducted over 12 years including patients who underwent appendicectomy, and the paediatric series (<16 years) was divided into age-groups-based quartiles. An anonymous questionnaire-based national survey was circulated among general and paediatric surgeons.
Results:
Of the 5784 appendicectomy patients, 2960 were children. LA rate in paediatric appendicitis was 65%. Yearly trends in LA reached a steady state in both groups after 2010 (Δ 0-1%/year). Rates of LA and LA IAA (respectively) differed significantly between age groups: 60, 3% (0-9 years); 65, 1% (10-13 years); 71, 2% (14-16 years) and 93, 3% (>16 years) (p = 0.001, 0.02). The national survey showed respondents believed LA was not superior to OA in paediatric patients except in terms of cosmesis. There was strong support in the use of LA in older children and children >40 kg.
Conclusion:
The use of LA in paediatric appendicectomies in the study region is similar to international rates, but not increasing over time. Irish surgeons still favour OA in younger children and prefer a case-by-case approach rather LA being the preferred pathway. This is despite the regional and international evidence showing favourable outcomes with LA in children.
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