[Initial experience with laparoscopic appendectomy in children]

The article generalizes the first experience in successful laparoscopic appendectomies in children carried out by the method suggested by F. Götz et al. which we modified and adapted to pediatric practice. In all cases of acute appendicitis the laparoscopic manipulation began with the diagnostic stageo by performing two abdominal punctures with small-diameter trocars. Laparoscopic appendectomy was undertaken only in recognized destructive appendicitis. It was conducted 205 times in children 2 to 14 years old in various localization of the vermiform process, including subhepatic and retroperineal. Complicated forms of appendicitis were encountered in 52 patients. Nineteen children had generalized purulent appendicitis, 18 had circumscribed peritonitis, and 11 children had a loose infiltrate and signs of circumscribed peritonitis. A peri-appendicular abscess was found in the remaining 4 children. All endoscopic operations were completed successfully. In 205 endoscopically removed vermiform processes the clinical and morphological signs were in full agreement, with the exception of one case in which secondary inflammatory changes were determined in the process when the clinical diagnosis was phlegmonous appendicitis. Six complications occurred in the postoperative period: abdominal infiltrate in two patients, which was cured by nonoperative measures, and an abdominal abscess in another two patients (one was treated by laparoscopic drainage and the other by laparotomy). Early adhesive obstruction developed in two cases and was removed laparoscopically. Fatal outcomes and complications connected with laparoscopy were not encountered.