Laparoscopic versus open appendectomy in children with complicated appendicitis

Abstract

Introduction: Acute appendicitis represents one of the most common causes of urgent surgical interventions in pediatric age group. With the advances in minimal invasive surgery laparoscopic appendectomy (LA) has been introduced as a suitable line of treatment. We compare between laparoscopic and conventional open appendectomy in the treatment of complicated appendicitis in children.

Patients and methods: During the period from October 2012 to March 2016, 390 children with acute complicated appendicitis diagnosed clinically and with laboratory and available imaging studies were operated. LA performed for 200 cases and open conventional appendectomy for 190 cases. Three ports technique was used in laparoscopic cases. The operating table is shifted in Trendelenburg position and towards the left side. The surgeon stands on the left side of the patient. The appendicular mesoappendix was secured using electro cautery. The base was secured by extracorporeal ties and the appendix was retrieval within the umbilical port. The wounds were closed. Open appendectomy was done through McBurny incision as the traditional approach.

Results: A total of 390 children diagnosed with acute complicated appendicitis were operated. The mean age was 12.04 years in group A and 12.2 in group B. There were 260 were boys and 130 were girls. The mean operative time in the laparoscopic group was 56.4 min; while in the conventional group was 63.42 min.

Conclusion: LA was a suitable, effective and safe procedure in complicated cases that did not involve the base. It was associated with lower complications rate with
all the advances of minimal invasive surgery when compared to the conventional open appendectomy.

Keywords: appendectomy, children, complicated, laparoscopic