[Pro and contra laparoscopic appendectomy in childhood]

The question should be cleared, if and to what extent the indication for appendectomy has changed since the beginning of the minimal invasive surgery in childhood. At first we had the chance to compare two patient groups in the different locations of the clinic for paediatric surgery in the Humboldt-University before their consolidation, because the indication for laparoscopic appendectomy was differently decided. The analysis of these two patient collectives (more than 50 children each) showed, beside the well known different preoperative parameters (age, sex allotment and anamnesis) the distinct indications finding for the minimal invasive procedure. In one group even the acute inflammatory appendicitis was excluded from the laparoscopic technique, in the other group only the sonographic proved perityphlitic abscess was excluded. In this group--corresponding to the more generous indication--there were more wound healing complications after phlegmonous and gangrenous appendicitis--even a little more (0.4%) than in a compared conventional operated collective. Cause of this reason the indication for the laparoscopic technique was defined more rigid (excluding the acute inflammatory disease), to get a high quality standard. The following 350 children after having appendektomy were analysed in the from now on merget locations under special consideration of postoperative complications. Including 54 laparoscopic procedures we saw significant less complications and registered a better average outcome including living quality criteria.