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In Vivo Measurements of Appendiceal Base - Implications on Pediatric Laparoscopic Appendectomy
Sanimir Suljendic1, Edin Husaric1, Amir Halilbasic1
1Department of Pediatric Surgery, University Clinical Center, Tuzla, Bosnia and Herzegovina. (Drs. Suljendic, Husaric, and Halilbasic).
Insights
Determining average pediatric appendix sizes is crucial for laparoscopic appendectomy. Larger appendix bases, especially in perforated cases, may require surgical staplers instead of standard clips.
Area of Science:
- Pediatric Surgery
- Surgical Instrumentation
- Appendicitis Research
Background:
- Securing the appendix base is critical in pediatric laparoscopic appendectomy.
- Understanding appendix dimensions aids instrument design and imaging research.
Purpose of the Study:
- To determine the average dimensions of the appendix in children with acute appendicitis.
- To provide data that can inform surgical instrument development and imaging studies.
Main Methods:
- One hundred and eight pediatric patients with acute appendicitis were randomized into two age groups (2-10 years and >10 years).
- Each group was further classified by appendicitis severity (phlegmonous, gangrenous, perforated).
- External diameter and length of the appendix were measured using Vernier calipers.
Main Results:
- In younger children (2-10 years), the average base diameter ranged from 5.68 mm (phlegmonous) to 6.94 mm (perforated).
- In older children (>10 years), the average base diameter ranged from 7.24 mm (gangrenous) to 9.31 mm (perforated).
- Appendix base diameter increased with severity, particularly in older children.
Conclusions:
- Observed maximum appendix sizes indicate that standard ligation clips may be insufficient.
- Surgical staplers may be necessary for securing larger appendix bases, impacting procedural costs.
Background And Objectives:
Securing the base of the appendix is the most critical part of laparoscopic appendectomy in children. Determining the average values of the appendix, will facilitate the creation of suitable instruments, and will also have an impact on research in imaging studies.
Methods:
One hundred and eight patients with the acute appendicitis were randomized into 2 groups: group I: children aged 2-10 years old, group II: children >10 years of age. Each group was further divided into 3 subgroups: phlegmonous, gangrenous and perforated forms of acute appendicitis. The external diameter of the appendiceal base, the middle part of the appendix, the tip and the length were determined. The measurements were made with the help of Vernier calipers, and expressed in millimeters.
Results:
In group I, the average size of the appendiceal base in the phlegmonous form was 5.68 ± 1.51 mm, in the gangrenous form 7.08 ± 1.82 mm, and in the perforated form 6.94 ± 2.43 mm. In group II, the average size of the appendiceal base in the phlegmonous form was 7.29 ± 2.75 mm, in the gangrenous form 7.24 ± 2.11 mm, and in the perforated form 9.31 ± 3.07 mm.
Conclusion:
Although most appendices can be removed by standard methods, the maximum sizes observed in this study reveal that standard endoloop or plastic and titanium clips cannot be used in the procedure and instead the more expensive stapler has to be utilized.
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