Should laparoscopic appendectomy be avoided for complicated appendicitis in children?

Area of Science:

• Pediatric Surgery
• Surgical Outcomes
• Infectious Complications

Background:

• Laparoscopic appendectomy is increasingly preferred for appendicitis.
• Adult studies suggest higher infectious risks with laparoscopy in complicated cases.
• Pediatric data on complicated appendicitis comparing open and laparoscopic approaches are limited.

Purpose of the Study:

• To compare the outcomes of open versus laparoscopic appendectomy for complicated appendicitis in children.
• To evaluate the incidence of postoperative complications, specifically intraabdominal abscesses, in pediatric patients.

Main Methods:

• Retrospective review of pediatric cases with complicated appendicitis from two institutions (1994-1996).
• Comparison of outcomes between children undergoing laparoscopic appendectomy and open appendectomy.
• Analysis included operating times, hospital stay, and postoperative complication rates.

Main Results:

• 56 children with complicated appendicitis were analyzed (27 laparoscopic, 22 open, 7 conversions).
• Laparoscopic appendectomy was associated with a significantly higher rate of postoperative complications (56% vs. 18%, P = .002).
• Intraabdominal abscesses were more frequent after laparoscopic appendectomy (41% vs. 9%, P = .01).

Conclusions:

• Laparoscopic appendectomy in children with complicated appendicitis is associated with an increased risk of intraabdominal abscesses.
• Open appendectomy may be a safer approach for complicated appendicitis in pediatric patients.
• A prospective, randomized trial is proposed to confirm these findings.