J Korean Surg Soc.  2009 Jan;76(1):47-51. 10.4174/jkss.2009.76.1.47.

Laparoscopic Appendectomy in Children with Perforated Appendicitis

• Nam SH
• Kim DY
• Kim SC
• Kim IK

• KMID: 2040604
• DOI: http://doi.org/10.4174/jkss.2009.76.1.47

Abstract

PURPOSE
It is controversial to do laparoscopic appendectomy in children with perforated appendicitis. Recently, we have adopted laparoscopic appendectomy as a first-choice method in children with perforated appendicitis. We investigate the results of laparoscopic appendectomy in perforated appendicitis and compare it with open technique.
METHODS
We studied retrospectively the patients who underwent the appendectomy by either a laparoscopic or open technique for perforated appendicitis between January 2001 and December 2005. There were 117 patients in the open appendectomy (OA) group and 45 patients in the laparoscopic (LA) group.
RESULTS
The operation times were significantly longer for the LA group than for the OA group (OA group 76.3+/-23.7 vs. LA group 95.4+/-32.4 min) (P<0.05). The hospital days were also longer in the LA group than the OA group (OA group 8.7+/-4.4 vs. LA group 11.0+/-6.3 (days)). However, there was no difference in time to diet (OA group: 5.0+/-3.3 vs. LA group: 5.4+/-2.9 (days)) (P>0.05) and in the rate of complications (OA group: 36/117 vs. LA group: 13/45) (P>0.05) between the two groups. The incidence of postoperative ileus, intraabdominal abscess and wound infection was lower in LA group, but not significantly.
CONCLUSION
Operation times and hospital days were longer in the LA group. But the incidence of complication was similar between the two groups. Considering little postoperative scar and less pain, laparoscopic appendectomy could be regarded as the optimal surgical therapy in children with perforated appendicitis.

Keyword

Perforated appendicitis; Laparoscopic appendectomy; Children

MeSH Terms

Abscess
Appendectomy
Appendicitis
Child
Cicatrix
Diet
Humans
Ileus
Incidence
Retrospective Studies
Wound Infection

Reference

1. Fishman SJ, Pelosi L, Klavon SL, O'Rourke EJ. Perforated appendicitis: prospective outcome analysis for 150 children. J Pediatr Surg. 2000. 35:923–926.

2. Meier DE, Guzzetta PC, Barber RG, Hynan LS, Seetharamaiah R. Perforated appendicitis in children: is there a best treatment? J Pediatr Surg. 2003. 38:1520–1524.

3. Newman K, Ponsky T, Kittle K, Dyk L, Throop C, Gieseker K, et al. Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg. 2003. 38:372–379.

4. Chen C, Botelho C, Cooper A, Hibberd P, Parsons SK. Current practice patterns in the treatment of perforated appendicitis in children. J Am Coll Surg. 2003. 196:212–221.

5. Moon KM, Kim DY, Kim SC, Kim IK. Mechanical intestinal obstruction after appendectomy for perforated appendicitis in children. J Korean Assoc Pediatr Surg. 2004. 10:123–126.

6. Semm K. Endoscopic appendectomy. Endoscopy. 1983. 15:59–64.

7. Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, et al. The European experience with laparoscopic cholecystectomy. Am J Surg. 1991. 161:385–387.

8. McHoney M, Eaton S, Wade A, Klein NJ, Stefanutti G, Booth C, et al. Inflammatory response in children after laparoscopic vs open Nissen fundoplication: randomized controlled trial. J Pediatr Surg. 2005. 40:908–913.

9. Kim SM, Kim SH, Choi HH, Han SJ, Choi SH, Hwang EH, et al. Acute appendicitis in children: comparison between present and 10 year ago. J Korean Assoc Pediatr Surg. 2007. 13:45–51.

10. Ortega AE, Hunter JG, Peters JH, Swanstrom LL, Schirmer B. A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic appendectomy study group. Am J Surg. 1995. 169:208–212.

11. Park JB, Sul JY. Laparoscopic appendectomy: a safe primary procedure for complicated appendicitis. J Korean Surg Soc. 2007. 72:51–56.

12. Kim MR, Jung JH, Kim EK, Song YT. The adequacy of laparoscopic appendectomy for simple and perforated appendicitis in children. J Korean Assoc Pediatr Surg. 2004. 10:127–130.

13. Lee SK, Lee CG, Seo JM, Lee SK. Laparoscopic vs. open appendectomy in children: a retrospective study. J Korean Pediatr Surg. 2007. 13:52–59.

14. Nguyen NT, Zainabadi K, Mavandadi S, Paya M, Stevens CM, Root J, et al. Trends in utilization and outcomes of laparoscopic versus open appendectomy. Am J Surg. 2004. 188:813–820.

15. Rangel SJ, Henry MC, Brindle M, Moss RL. Small evidence for small incisions: pediatric laparoscopy and the need for more rigorous evaluation of novel surgical therapies. J Pediatr Surg. 2003. 38:1429–1433.

16. Lintula H, Kokki H, Vanamo K, Antila P, Eskelinen M. Laparoscopy in children with complicated appendicitis. J Pediatr Surg. 2002. 37:1317–1320.

17. Vernon AH, Georgeson KE, Harmon CM. Pediatric laparoscopic appendectomy for acute appendicitis. Surg Endosc. 2004. 18:75–79.

18. McKinlay R, Neeleman S, Klein R, Stevens K, Greenfeld J, Ghory M, et al. Intraabdominal abscess following open and laparoscopic appendectomy in the pediatric population. Surg Endosc. 2003. 17:730–733.

19. Canty TG Sr, Collins D, Losasso B, Lynch F, Brown C. Laparoscopic appendectomy for simple and perforated appendicitis in children: the procedure of choice? J Pediatr Surg. 2000. 35:1582–1585.

20. Lippert H, Koch A, Marusch F, Wolff S, Gastinger I. Open vs. laparoscopic appendectomy. Chirurg. 2002. 73:791–798.

21. Frazee RC, Bohannon WT. Laparoscopic appendectomy for complicated appendicitis. Arch Surg. 1996. 131:509–511.

22. Novitsky YW, Litwin DE, Callery MP. The net immunologic advantage of laparoscopic surgery. Surg Endosc. 2004. 18:1411–1419.

23. Jung JY, Lee WY, Yang KH, Bae BN, Kim KH, Han SW, et al. The clinical value of laparosopic appendectomy for complicated appendicitis, such as perforated periappendiceal abscess and overweight patients. J Korean Soc Endosc Laparosc Surg. 2007. 10:39–44.