[APPENDECTOMY FOR COMPLICATED APPENDICITIS IN CHILDREN--LAPAROSCOPIC OR OPEN?].

INTRODUCTION

Laparoscopic appendectomy (LA) is widely accepted for simple appendicitis but it is still debatable in complicated cases (gangrenous or perforated appendicitis).

AIM

The purpose of the present study was to evaluate the outcomes of LA versus open appendectomy (OA) in uncomplicated and complicated appendicitis in children.

METHODS

A retrospective analysis of the clinical data of children (< 18 years old) who underwent LA and CA from 2008 to 2011 was performed. The incidental appendectomies were excluded. The patients were divided into four groups according to the severity of the disease (uncomplicated vs complicated) and by the surgical approach (LA vs OA). Data were compared with regard to demographic features, pre-operative, intra-operative and post-operative findings.

MAIN RESULTS

A total of 335 children underwent urgent appendectomy during this period. The overall rate of perforated appendicitis was 26.9%; 143 patients (42.7%) underwent LA and 192 patients (57.3%) underwent CA. Operative times and complication rates did not differ significantly between LA and OA in either complicated to uncomplicated appendicitis; LOS was shorter in the uncomplicated group (2.14 ± 0.17 vs 3.15 ± 0.14, p < 0.01). Two patients from the uncomplicated group underwent conversions form LA to OA (conversion rate of 1.36%) because of intraoperative bleeding, and one patient in the OA-complicated group had a cecal injury. There were no mortalities in this group.

CONCLUSIONS

Laparoscopic appendectomy for complicated appendicitis in children is feasible and safe, does not harbor any risks in comparison to the open traditional procedure, and allows the benefits of better view, flexible angle of approach and cosmesis.