Laparoscopic appendectomy for complicated appendicitis with periappendiceal abscess versus without abscess in...

To date, no prospective studies have focused on laparoscopic treatment for complicated appendicitis in children with or without abscess. This study aimed to evaluate the safety and efficacy of laparoscopic treatment for complicated appendicitis in children with and without abscess prospectively.

A single-center, non-randomized, prospective clinical pilot study conducted from January 2021 to December 2023. This prospective cohort study comparing laparoscopic appendectomy in pediatric patients with acute complicated appendicitis with and without abscess. A total of 190 patients with complicated appendicitis were admitted to our department from January 2021 to December 2023. After exclusions, 183 patients were finally enrolled for analysis. Laparoscopic appendectomy was used for the treatment of complicated appendicitis in children. Main outcomes included the incidence of postoperative intestinal obstruction, intra-abdominal abscess, surgical site infections, and readmission. Secondary outcomes included operation time, blood loss, hospital stay, and total costs.

A total of 184 patients were enrolled, and 183 patients were finally included in the analysis after excluding one case with incomplete laparoscopic appendectomy. Statistically significant difference was noted in terms of operation time, blood loss, and total costs between the two groups of patients (P < 0.05). Compared with the group without abscess, laparoscopic appendectomy for the treatment of complicated appendicitis with abscess had a longer median (range) operation time (100 [71,130] minutes vs. 60 [47,75] minutes; respectively, P < 0.001), higher median (range) hospital costs (14,147 RMB (11,019-16168 RMB) vs. 11,021 RMB (9917-12,550 RMB); respectively, P < 0.001), more median (range) blood loss (5ml (1-50ml) vs. 2ml (1-20ml) respectively, P < 0.001),and longer hospital stay (9 days (8,12 days) vs. 8 days (6,10 days), respectively; P < 0.001).

In this prospective study, we found that laparoscopic appendectomy for complicated appendicitis with abscess in children was safe and efficacious, with the outcomes comparable to complicated appendicitis without abscess. The adoption of laparoscopy did not lead to an increase in postoperative complications. While operation time and blood loss were marginally higher, these increases remained within an acceptable threshold.