Complicated appendectomy in children in relation to laparoscopic vs open procedures.

The role of laparoscopic appendectomy in the management of complicated appendicitis remains unsettled with reports of a higher incidence of postoperative intraperitoneal abscess. Most studies on laparoscopic appendectomy in children have been done in the Western population. This retrospective review has been done to compare laparoscopic appendectomy with open appendectomy in children with complicated appendicitis in Chittagong Medical Hospital, Bangladesh. Based on intention-to-treat analysis, there were 51 and 61 children in the laparoscopic and open appendectomy groups, respectively. Conversion from laparoscopy to open technique was done in six children. Distribution of age, gender and pathology of appendicitis was similar for the two groups. With laparoscopic appendectomy, the mean operative time was longer (112 vs 72 minutes, p-value is less than 0.005), while severe wound infection (2.1 vs 21 percent, p-value is less than 0.05) and mean postoperative hospital stay (5.7 vs 7.4 days, p-value is less than 0.005) were significantly lower. The incidence of postoperative intraperitoneal abscess (12 vs 11.5 percent) and postoperative fever (20 vs 11.5 percent) were not significantly different (p-value is greater than 0.05). This review has confirmed that the longer the operating time, the lower the incidence of wound infection and shorter the postoperative stay for laparoscopic appendectomy. There was no increased risk of postoperative intraperitoneal abscess (Tab. 1, Fig. 15, Ref. 35). Full Text (Free, PDF) www.bmj.sk.