Outcomes for open and laparoscopic appendicectomy for complicated appendicitis in children

Area of Science:

• Pediatric Surgery
• Surgical Education

Background:

• Compares outcomes of pediatric laparoscopic appendectomy (LA) versus open appendectomy (OA) for complicated appendicitis (CA).
• Highlights that all trainees could perform OA unsupervised.

Purpose of the Study:

• To compare complication rates between LA and OA in children with CA.
• To evaluate the learning curve and proficiency of surgical trainees in performing LA.

Main Methods:

• Retrospective, single-center review of children aged 4-12 undergoing OA or LA for CA (August 2012 - June 2016).
• Analysis of intraoperative and postoperative complications, with a primary endpoint of infection rates.
• Trainee supervision and operative approach decision-making by on-call surgeons were documented.

Main Results:

• 90 patients underwent OA and 51 underwent LA; groups were demographically matched.
• Postoperative infective complication rates were similar: 25.5% for LA vs. 25.6% for OA (p=0.159).
• Trainees performed 27 LAs unsupervised; mean trainee LA duration (110.35 min) was comparable to consultant duration (93.87 min, p=0.497).

Conclusions:

• No significant difference in intra- and postoperative complications between LA and OA for CA.
• Surgical trainees demonstrated comparable operative times to consultants after a short learning period.
• LA is a suitable laparoscopic teaching procedure for pediatric surgical trainees.