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Randomized, single-blinded trial of laparoscopic versus open appendectomy in children: effects on postoperative
C Lejus1, L Delile, V Plattner
1Service d'Anesthésie et de Reanimation Chirurgicale, Bloc opératorie de Chirurgie Pédiatrique, Nantes, France.
Insights
Laparoscopic appendectomy in children did not show improved pain relief or faster recovery compared to open surgery. Both methods had similar outcomes for feeding, walking, and overall analgesia quality.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Laparoscopic surgery benefits are established for adult cholecystectomy but less clear for pediatric appendectomy.
- This study compares 3-day postoperative outcomes of laparoscopic versus open appendectomy in children.
Purpose of the Study:
- To compare postoperative recovery and analgesia between laparoscopic and open appendectomy in children.
- To evaluate pain, feeding, mobility, and analgesic use in pediatric appendectomy patients.
Main Methods:
- Sixty-three children (8-15 years) were randomized to laparoscopic or open appendectomy.
- Postoperative assessment included recovery delays (walking, feeding), pain via visual analog scale, and patient-controlled nalbuphine analgesia.
- Evaluated responses from children, parents, and nurses on analgesia quality.
Main Results:
- No significant differences were found in recovery, analgesia, sedation, or adverse events between groups.
- Laparoscopic appendectomy had a longer operative time (54 min) than open appendectomy (39 min).
- Shoulder pain occurred in 35% of laparoscopic cases versus 10% of open cases.
Conclusions:
- Laparoscopic appendectomy does not offer advantages in analgesia or postoperative recovery for children.
- Open appendectomy remains a viable and comparable option for pediatric appendectomy regarding recovery and pain management.
Background:
The benefit of laparoscopy to patients has been clearly established in adults undergoing cholecystectomy. Results are less clear for appendectomy. The current study was undertaken to compare the respective 3-day postoperative periods after laparoscopic and open appendectomy in children.
Methods:
Sixty-three children (aged 8-15 yr) scheduled for appendectomy were randomly assigned to two groups: open and laparoscopic. Postoperative evaluation included delay of postoperative recovery (walking and feeding), pain assessment by visual analog scale during the 3 subsequent days, amount of nalbuphine administered via a patient-controlled analgesia system during the first 48 h and responses by children, parents, and nurses on the overall quality of analgesia.
Results:
There was no difference between groups for demographic data (particularly macroscopic aspect of appendix) analgesia, sedation, delay before eating and walking, incidence of urinary retention, nausea, vomiting. Operative time was long (P < or = to 0.05) in the laparoscopic group (54 +/- 17 min) than in the open group (39 +/- 18 min). Thirty five percent of the children had pain at the shoulder in the LAP group versus ten percent in the open group (P < or = 0.05).
Conclusions:
Laparoscopy did not improve analgesia and postoperative recovery after appendectomy in children.