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A population-based comparison of the post-operative outcomes of open and laparoscopic appendicectomy in children

Francisco J Schneuer1, Susan E Adams2, Jason P Bentley3

  • 1Menzies Centre for Health Policy, University of Sydney, Sydney, NSW francisco.schneuer@sydney.edu.au.

The Medical Journal of Australia
|July 7, 2018
PubMed

Insights

Laparoscopic appendicectomy in children shows fewer bowel obstructions but more complications for uncomplicated appendicitis. Outcomes are similar for complicated appendicitis, though wound infections are reduced with laparoscopy.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Surgical Outcomes Research

Background:

  • Appendicectomy is a common surgical procedure in children.
  • Minimally invasive techniques like laparoscopic appendicectomy are increasingly used.
  • Comparative data on open versus laparoscopic appendicectomy outcomes in pediatric populations is crucial.

Purpose of the Study:

  • To compare post-operative outcomes between open and laparoscopic appendicectomy in children.
  • To identify specific complications associated with each surgical approach.
  • To evaluate the impact of appendicectomy type on different appendicitis severities.

Main Methods:

  • Retrospective analysis of linked administrative hospital and emergency department data.
  • Inclusion of children under 16 who underwent appendicectomy in New South Wales (2002-2013).
  • Statistical analysis to compare post-operative complications within 28 days, adjusting for patient and hospital characteristics.

Main Results:

  • Laparoscopic appendicectomy was associated with more post-operative complications in uncomplicated appendicitis but reduced intestinal obstruction risk.
  • For complicated appendicitis, laparoscopic appendicectomy showed lower wound infection rates but similar risks for obstruction and intra-abdominal abscess.
  • The proportion of laparoscopic appendicectomies rose significantly from 11.8% to 85.8% during the study period.

Conclusions:

  • Laparoscopic appendicectomy offers a reduced risk of post-operative bowel obstruction in children with uncomplicated appendicitis.
  • While laparoscopic appendicectomy may lead to more symptomatic re-admissions in uncomplicated cases, it reduces wound infections in complicated cases.
  • Careful discharge planning is needed to ensure adequate resolution of symptoms after laparoscopic appendicectomy.
Abstract

Keywords:
Digestive system surgical proceduresHealth policyLaparoscopyMinimally invasive surgical proceduresPaediatric surgery

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