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Predictive factors of post-laparoscopic appendectomy peritoneal collection in children and adolescents with
Mohammad Gharieb Khirallah1, Nagi Ebrahim Elsossuky1, Mohamed Ghazaly2
1Department of Pediatric Surgery, Tanta University, Tanta, Egypt.
Insights
Intra-peritoneal collection (IPC) after laparoscopic appendectomy for complicated appendicitis is common. Higher white blood cell counts, longer symptom duration, comorbidities, and longer operative times predict IPC development in children.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Complications
Background:
- Intra-peritoneal collection (IPC) is a significant complication following laparoscopic appendectomy (LA) for complicated appendicitis in children.
- IPC leads to increased hospital stays, costs, and parental distress.
- Identifying risk factors for IPC is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate factors influencing the development of intra-peritoneal collection (IPC) after laparoscopic appendectomy (LA) in children with complicated appendicitis.
Main Methods:
- A retrospective study of 75 children who underwent LA for complicated appendicitis between January 2016 and October 2020.
- Patients were categorized into two groups: those with (n=19) and without (n=56) post-operative IPC.
- Univariate and multivariate logistic regression analyses were used to identify risk factors for IPC.
Main Results:
- The incidence of post-operative IPC was 25.3% (19 out of 75 patients).
- Significant predictors of IPC included elevated total leucocytic count (TLC), prolonged symptom duration, pre-operative morbidity, and longer operative time.
- Multivariate analysis confirmed TLC (OR: 1.358), symptom duration (OR: 2.051), morbidity (OR: 2.064), and operative time (OR: 2.631) as independent predictors.
Conclusions:
- Post-operative IPC is a frequent complication after LA for complicated appendicitis in children.
- Elevated TLC, prolonged symptoms, co-morbidity, and operative time are key predictors of IPC.
- Optimizing patient condition, surgical technique, and reducing operative time may decrease IPC incidence.
Introduction:
Intra-peritoneal collection (IPC) following laparoscopic appendectomy (LA) of complicated appendicitis in children is a serious complication. This is associated with a longer duration of hospital stay, more costs, and psychological upsets of both children and their parents. The aim of this study is to evaluate different factors that may affect the development of IPC following LA of complicated appendicitis.
Patients And Methods:
Seventy-five children were admitted with acute complicated appendicitis. All of them had LA between January 2016 and October 2020. The following variables were studied: patients' demographics, clinical findings, laboratory and imaging studies and operative parameters. Patients were divided according to their post-operative course into two groups; Group (A): patients with IPC (n = 19), Group (B): patients without IPC (n = 56). Potential risk factors for the development of post-operative IPC were identified by univariate and multivariate logistic regression analysis.
Results:
Nineteen cases (25.3%), out of 75 patients, presented with post-operative collection. Forty-seven (62.7%) patients were males, the overall median age was 11 (inter-quartile range [IQR] 10-13). The most significant operative variable was the operative time, which was significantly longer in Group A, 78 min (IQR 75-88) versus 56 (50-66), P = 0.001. The following variables were associated with an elevated incidence of post-operative IPC; age, body mass index, total leucocytic count (TLC), duration of symptoms, pediatric appendicitis score, pre-operative morbidity, being on medications, operative time, suction and irrigation or suction only and drain duration. In the multivariate model, TLC (odds ratios [OR]: 1.358, P 0.006), symptoms duration (OR: 2.051, P 0.012), morbidity (OR: 2.064, P 0.041) and operative time (OR: 2.631, P 0.039) were statistically significant and confirmed as being predictors of IPC post-LA in complicated appendicitis.
Conclusion:
Post-operative IPC is quite common after LA for complicated appendicitis. Increased TLC, prolonged symptoms duration, associated co-morbidity and operative time could be predictors of its occurrence. Improving general condition, surgical technique and reducing operative time help to reduce its incidence.
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