Feasibility of Laparoscopic Appendectomy Among Children in Nepal: A Safe and Preferred Approach

Background Acute appendicitis is a common condition in children, and appendectomy is the treatment of choice. The laparoscopic approach has many advantages over the open approach and should be the first choice. Open appendectomy is still a common practice in Nepal. Although laparoscopic appendectomy offers advantages over open surgery, its feasibility in the pediatric population of resource-limited settings like Nepal has not been well studied. This study was conducted to determine the feasibility of laparoscopic appendectomy in terms of technical difficulty, operating time, complications, and early recovery without further adding the risks of general anaesthesia. Methods This was a single-centred prospective observational study conducted at a tertiary centre hospital in Nepal for the period of one year. All children between the ages of 5 and 15 with acute appendicitis were included in the study and followed up till day 30 after discharge. Data were entered in Microsoft Excel (Microsoft Corp., Redmond, WA, USA), and the statistical calculations were carried out using Statistical Package for the Social Sciences (SPSS) version 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive and inferential statistical measures were used for data analysis, and the results are represented in tables. Results Altogether, 17 children (53.12%) were between 11 and 15 years old, with a male predominance. Most of the patients presented early to the hospital, with a mean duration of 18 hours after the onset of symptoms. Seven children (21.88%) had an appendicolith and four children (12.50%) had a perforation at the shaft. Mean operative time was 44.9 ± 15 minutes. There were no intra-operative and immediate post-operative complications as well as the need of conversion to open. All children tolerated the general anaesthesia well. Only one (3.13%) patient had umbilical port surgical site infection (Southampton Grade Ic and Clavien-Dindo Grade I). Most of the patients were discharged on the second day, and none of them required readmission. Conclusions In the hands of experienced surgeons, laparoscopic appendectomy appears safe and feasible among children in a resource-limited country like Nepal. Intra-operative and post-operative complications appear minimal, allowing for early discharge with a small scar.