Moraitis D, Kini S U, Annamaneni R K, Zitsman J L
Department of Surgery, Our Lady of Mercy Medical Center and New York Medical College, Bronx, New York, USA.
JSLS. 2004 Oct-Dec;8(4):310-3.
Complicated appendicitis (gangrenous or perforated) has been associated with increased risk for postoperative complications, especially intraabdominal abscess. Caution has been advised when attempting laparoscopic appendectomy for complicated appendicitis in children. The objective of our study was to assess the incidence of intraabdominal abscess formation after laparoscopic appendectomy in pediatric patients presenting with complicated appendicitis.
This is a retrospective review of 52 pediatric patients presenting with acute appendicitis at a single teaching institution who underwent laparoscopic appendectomy by a single surgeon. All laparoscopic procedures were completed without conversion. Treatment complications and outcomes were recorded for all cases.
Five of the 52 patients (10%) had complicated appendicitis. One of the 5 patients (20%) developed intraabdominal abscess postoperatively and underwent laparoscopic drainage during the same admission. No other complications were noted. None of these patients was readmitted for wound infections or intraabdominal abscesses. The single postoperative abscess occurred early during our initial experience with laparoscopic appendectomy.
Laparoscopic appendectomy seems to be a safe alternative for the treatment of complicated appendicitis in children. Caution is recommended during the initial experience of surgeons with this procedure, because the complication rate seems to be higher during the learning curve. Close postoperative follow-up and a high index of suspicion for development of complications is recommended. As surgeons' experience accumulates, the safety of the procedure seems to increase. A prospective, randomized trial is recommended to establish the role of laparoscopy in complicated appendicitis in the pediatric population.
复杂性阑尾炎（坏疽性或穿孔性）与术后并发症风险增加相关，尤其是腹腔内脓肿。对于儿童复杂性阑尾炎行腹腔镜阑尾切除术时需谨慎。我们研究的目的是评估患有复杂性阑尾炎的儿科患者行腹腔镜阑尾切除术后腹腔内脓肿形成的发生率。
这是一项对单一教学机构中52例急性阑尾炎儿科患者的回顾性研究，这些患者均由同一位外科医生进行腹腔镜阑尾切除术。所有腹腔镜手术均未中转开腹。记录所有病例的治疗并发症及结果。
52例患者中有5例（10%）患有复杂性阑尾炎。5例患者中有1例（20%）术后发生腹腔内脓肿，并在同一住院期间接受了腹腔镜引流。未发现其他并发症。这些患者均未因伤口感染或腹腔内脓肿再次入院。术后唯一的脓肿发生在我们最初进行腹腔镜阑尾切除术的早期阶段。
腹腔镜阑尾切除术似乎是治疗儿童复杂性阑尾炎的一种安全选择。在外科医生初次开展该手术时建议谨慎操作，因为在学习曲线阶段并发症发生率似乎更高。建议术后密切随访并对并发症的发生保持高度怀疑。随着外科医生经验的积累，该手术的安全性似乎会提高。建议进行一项前瞻性随机试验，以确定腹腔镜检查在儿科人群复杂性阑尾炎中的作用。
