Shalak Firas, Almulhim Saad I, Ghantous Saleem, Yazbeck Salam
Dhahran Health Center, Dhahran, Saudi Arabia.
J Laparoendosc Adv Surg Tech A. 2009 Jun;19(3):427-9. doi: 10.1089/lap.2008.0109.
Although laparoscopic appendectomy (LA) is now a common practice, it has not yet become the standard of care because it has no clear advantage when compared to open appendectomy (OA), especially in cases of complicated appendicitis. Moreover, the literature reports an increased incidence of postoperative infections with LA.
To review our center's experience with LA and to compare it to the literature.
All LAs performed between January 2004 and October 2007 were retrospectively reviewed for age, gross operative findings, pathology reports, operating time, length of hospital stay (LOS), and the time to resume regular diet and reach afebrile status. All patients who presented with phlegmonous appendicitis were treated medically and had a secondary appendectomy.
A total of 151 children underwent LA during this period (60 girls, 91 boys); the mean age was 10.4 years (range, 4-16). Forty-five patients (29.8%) presented with perforated appendicitis (PA). Nine patients had normal appendix on pathology. The mean operative time was 58.7 minutes (56.1 minutes for simple appendicitis [SA] and 64.8 minutes for PA). The mean intravenous narcotic analgesia duration was 12.2 hours for SA and 15.1 hours for PA. LOS was 2.82 days for SA and 3.8 days for PA. Regular diet was tolerated 1.47 days postoperatively for SA and 2.4 days for PA. The latter patients remained febrile for an average of 1.9 days. None of the patients presented with intra-abdominal infection postoperatively. Seven patients (4.6%) presented a trocar site infection. Since the introduction of a routine LA in 2004, the operating room time decreased from 66.4 minutes to 51 minutes.
This series confirms the safety of LA in almost all cases. The absence of intra-abdominal infections and the low rate of wound infections noted with LA compare favorably with the open approach. This approach is not only advantageous for cosmesis but also allows satisfying parents' requests, helps developing surgeons' laparoscopic skills, and is cost-effective.
尽管腹腔镜阑尾切除术（LA）目前已较为常见，但它尚未成为标准治疗方法，因为与开腹阑尾切除术（OA）相比，它没有明显优势，尤其是在复杂阑尾炎病例中。此外，文献报道LA术后感染发生率增加。
回顾我们中心LA的经验并与文献进行比较。
对2004年1月至2007年10月期间进行的所有LA进行回顾性分析，内容包括年龄、手术大体所见、病理报告、手术时间、住院时间（LOS）以及恢复正常饮食和退热的时间。所有出现蜂窝织炎性阑尾炎的患者均接受药物治疗并进行二期阑尾切除术。
在此期间共有151名儿童接受了LA（60名女孩，91名男孩）；平均年龄为10.4岁（范围4 - 16岁）。45例患者（29.8%）为穿孔性阑尾炎（PA）。9例患者阑尾病理结果正常。平均手术时间为58.7分钟（单纯性阑尾炎[SA]为56.1分钟，PA为64.8分钟）。SA的平均静脉麻醉镇痛持续时间为12.2小时，PA为15.1小时。SA的LOS为2.82天，PA为3.8天。SA术后1.47天可耐受正常饮食，PA为2.4天。后者患者平均发热1.9天。所有患者术后均未出现腹腔内感染。7例患者（4.6%）出现套管针穿刺部位感染。自2004年引入常规LA以来，手术室时间从66.4分钟降至51分钟。
本系列研究证实了LA在几乎所有病例中的安全性。LA未出现腹腔内感染且伤口感染率低，与开腹手术相比具有优势。这种方法不仅有利于美观，还能满足家长的要求，有助于培养外科医生的腹腔镜技术，且具有成本效益。
