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Kiblawi R, Zoeller C, Zanini A, Kuebler JF, Dingemann C, Ure B, Schukfeh N. Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies. Eur J Pediatr Surg 2022; 32:9-25. [PMID: 34933374 DOI: 10.1055/s-0041-1739418] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. We reviewed the literature on studies published in the last three decades and dealing with advantages and disadvantages of laparoscopy compared to open surgery. MATERIALS AND METHODS Studies comparing laparoscopic versus open abdominal procedures in children were searched in PubMed/MEDLINE. Reports on upper and lower gastrointestinal as hepatobiliary surgery and on surgery of pancreas and spleen were included. Advantages and disadvantages of laparoscopic surgery were analyzed for different types of procedures. Complications were categorized using the Clavien-Dindo classification. RESULTS A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien-Dindo grade I to III complications (mild-moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency of reporting on advantages after laparoscopy and increased reporting on disadvantages for all surgery types over the decades. CONCLUSION Laparoscopic compared with open pediatric surgery seems to be beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.
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Affiliation(s)
- Rim Kiblawi
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Zoeller
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.,Department of Pediatric Surgery, University Hospital Munster, Munster, Nordrhein-Westfalen, Germany
| | - Andrea Zanini
- Department of Pediatric Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Carmen Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Nagoud Schukfeh
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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Chowdhury MZ, Farooq MAA, Rahman MAM, Chowdhury TK. Management of early appendicular lump in children - laparoscopic technique versus open surgery: a comparative study in low-middle income country perspective. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000131. [DOI: 10.1136/wjps-2020-000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/04/2022] Open
Abstract
BackgroundIn the pediatric population, appendectomy is one of the most common emergency operations. Laparoscopic appendectomy (LA) is an accepted way of dealing with suspected uncomplicated appendicitis in children. The role of laparoscopy in appendicular lump is more controversial and remains undefined and is not well practiced in low-middle income countries. The aim of this study was to determine a better surgical treatment plan for early appendicular lump in children.MethodsThis prospective observational study was performed in Pediatric Surgery Department of Chittagong Medical College and Hospital for a period of 1 year from April 2018 to March 2019. Sixty children with appendicular lump selected consecutively as per eligibility criteria underwent either LA or open appendectomy (OA), that is, 30 children per group. They were followed up until hospital discharge to observe outcomes.ResultsThere were no differences in terms of patient’s age, sex, clinical presentation and laboratory findings between the two groups. Postoperative pain severity was significantly less in the LA group than that in the OA group (p<0.01). The incidence of wound infection was significantly lower in the LA group than that in the OA group (6.7% in LA and 46.7% in OA; p<0.01). Children in the LA group had a shorter duration of hospital stay in comparison to the OA group [median (IQR) was 8 (5.75–11.25) days and 12 (7.75–18.00) days, respectively, in LA and OA groups; p=0.01].ConclusionThe study findings suggest that LA is feasible and should replace OA in cases of early appendicular lump in children.
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Pastore V, Cocomazzi R, Basile A, Niglio F, Bartoli F. Development in the surgical treatment of acute appendicitis: A single-center experience. Afr J Paediatr Surg 2020; 17:5-9. [PMID: 33106445 PMCID: PMC7818663 DOI: 10.4103/ajps.ajps_77_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Laparoscopy has become the treatment of choice for acute appendicitis. The aim of the study was to compare open (OA) and laparoscopic (LA) approaches in all forms of acute appendicitis. METHODOLOGY Two hundred and ninety-two children underwent appendectomy (238 LA/54 OA). 3/238 patients required conversion. LA surgical technique has been modified by closing also the distal stump of appendix (DSC) before removing it. RESULTS Early experience: 130 appendectomy, 44 by OA (34%), and 86 by LA (66%). The mean operative time was similar for both techniques. Complicated appendicitis (CA) was observed in 14 patients (11%). 10 patients treated with OA (10/14 = 71%) and 4 with LA (4/14 = 29%). Complications occurred mainly in the LA group without statistical significance. LATE EXPERIENCE One hundred and sixty-two appendectomy, 10 OA (6.17%), and 152 LA (93.8%). Thirty-eight children (23.4%) had CA. The mean operative time was lower in LA group without reaching statistical significance. Total complication rate (CR) was 7.4%. CR in patients with DSC was null and significantly lower when compared to patients without DSC. CONCLUSION Our results demonstrated that nearly all cases of appendicitis may be managed by laparoscopy. Ligature of distal appendiceal stump is a trick that may significantly improve outcomes during LA appendectomy.
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Affiliation(s)
- Valentina Pastore
- Department of Medical and Sugical Science, Pediatric Surgical Unit, Azienda Ospedaliera-Universitaria "Ospedali Riuniti Foggia", University of Foggia, Foggia, Italy
| | - Raffaella Cocomazzi
- Department of Medical and Sugical Science, Pediatric Surgical Unit, Azienda Ospedaliera-Universitaria "Ospedali Riuniti Foggia", University of Foggia, Foggia, Italy
| | - Angela Basile
- Department of Medical and Sugical Science, Pediatric Surgical Unit, Azienda Ospedaliera-Universitaria "Ospedali Riuniti Foggia", University of Foggia, Foggia, Italy
| | - Francesco Niglio
- Department of Medical and Sugical Science, Pediatric Surgical Unit, Azienda Ospedaliera-Universitaria "Ospedali Riuniti Foggia", University of Foggia, Foggia, Italy
| | - Fabio Bartoli
- Department of Medical and Sugical Science, Pediatric Surgical Unit, Azienda Ospedaliera-Universitaria "Ospedali Riuniti Foggia", University of Foggia, Foggia, Italy
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Serrano M, Giraldo D, Ordóñez JM, Rengifo HA. Apendicectomía por único puerto asistida por laparoscopia versus técnica abierta convencional localizada, en pacientes con apendicitis aguda en el Hospital Universitario Clínica San Rafael. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introducción. La apendicectomía por puerto único, asistida por laparoscopia, ofrece una alternativa terapéutica en el abordaje de la apendicitis aguda. En el presente estudio, se evalúa el beneficio terapéutico de la técnica por único puerto asistida por laparoscopia y se compara esta técnica con la apendicectomía abierta.
Materiales y métodos. Se trata de un estudio observacional analítico retrospectivo de cohorte, llevado a cabo en el Hospital Universitario Clínica San Rafael, de Bogotá. Se incluyeron 106 pacientes mayores de 15 años con apendicitis aguda, que fueron sometidos a apendicectomía por puerto único, asistida por laparoscopia o apendicectomía abierta. La relación entre el grupo con apendicectomía por laparoscopia y el de técnica abierta, fue de 1:1. Se incluyeron variables sociodemográficas, clínicas y quirúrgicas (tiempo quirúrgico, frecuencia de infección del sitio operatorio, estancia hospitalaria, dolor, reingresos y resultado estético).
Resultados. La edad promedio fue de 32 años y la mayoría de los pacientes eran de sexo masculino. El tiempo operatorio fue menor en los casos de apendicectomía por puerto único, asistida por laparoscopia, con un promedio de 34,1 minutos. Según la escala análoga, el dolor posoperatorio fue de 2,2 con la técnica laparoscópica y de 3,2 con la apendicectomía abierta (p<0,05). Hubo ocho veces más reingresos entre los casos de apendicectomía abierta en comparación con la apendicectomía por un puerto, y el resultado estético fue satisfactorio en todos con esta última técnica. No se encontraron diferencias significativas en la estancia hospitalaria o la infección del sitio operatorio. La razón de momios (odds ratio, OR) fue inferior a 1 en variables como dolor, reingreso y menor tiempo quirúrgico, lo cual indica una menor probabilidad, en los que se usó un solo puerto.
Discusión. La técnica por un solo puerto es segura, reproducible, equiparable en términos de días de estancia hospitalaria e infección de sitio operatorio, e incluso, produce mejores resultados en el tiempo quirúrgico, las escalas de dolor y el número de reingresos.
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Laparoscopic Appendectomy in Children With Perforated Appendicitis: A Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2018; 27:262-266. [PMID: 28472016 DOI: 10.1097/sle.0000000000000411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The purpose of this meta-analysis was to compare the influence of different surgical procedures on perforated appendicitis in pediatric population. MATERIALS AND METHODS Studies were identified through a computerized literature search of Pubmed, Embase, Ovid, the Cochrane Colorectal Cancer Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, the Cochrane Library database, and Web of Science. Two reviewers independently assessed the quality of each study and abstracted outcome data. Data were extracted comparing laparoscopic appendectomy (LA) and open appendectomy (OA) in pediatric population with regard to several postoperative variables. We synthesized published data using fixed-effect models, expressing results as relative risk (RR). RESULTS Nine eligible studies were included which came from various medical centers all over the world. Statistically significant differences between "LA" and "OA" groups were found for wound infection (RR=0.88), intra-abdominal abscess (RR=1.38), and bowel obstruction (RR=0.79). CONCLUSIONS Our meta-analysis found that LA is associated with lower incidence of wound infections and bowel obstruction, but the rate of intra-abdominal abscess was higher than OA.
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Laparoscopic versus open appendectomy in children: a randomized controlled trial from a developing country. J Pediatr Surg 2018; 53:247-249. [PMID: 29223666 DOI: 10.1016/j.jpedsurg.2017.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/08/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute appendicitis is a common surgical emergency. This study was conducted to compare the outcome in terms of duration of surgery, length of hospital stay, and wound infection rate following laparoscopic versus open appendectomy in children with acute appendicitis. METHODS A prospective randomized controlled trial was conducted. Patients with the diagnosis of acute appendicitis were randomly assigned to Group A: Laparoscopic appendectomy (LA) and Group B: Open appendectomy (OA). Age and sex of patients, signs, and symptoms were noted. Duration of surgery, length of hospital stay (LOS), and postoperative wound infection were recorded. RESULTS A total of 126 patients were operated, with 63 in each group. Mean age of the patients was 9.7±2.1years in LA group and 9.8±2.3years in OA group. In LA group, inflamed appendix was found in 68% patients, perforated in 17%, gangrenous in 9%, and suppurative in 5%. In OA group, inflamed appendix was found in 60% patients, perforated in 22%, gangrenous in 5%, and suppurative in 13%. The mean duration of operation was 56±24min in LA group and 39±8min in OA group (p<0.0001 in favor of OA group). The mean length of hospital stay was 34±13h in LA group and 40±11h in OA group (p=0.01 in favor of LA group). The results showed no significant association of wound infection between the two groups (p=0.31). CONCLUSION There was no difference in terms of LOS and rate of wound infection among the groups. However, the laparoscopic procedure was technically demanding. LEVEL OF EVIDENCE Level I Randomized Controlled Trial.
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Ousley R, Burgoyne LL, Crowley NR, Teague WJ, Costi D. An audit of patient-controlled analgesia after appendicectomy in children. Paediatr Anaesth 2016; 26:1002-9. [PMID: 27373867 DOI: 10.1111/pan.12964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patient-controlled analgesia (PCA) is commonly used after appendicectomy in children. AIM The aim of this study was to characterize the analgesic use of children prescribed PCA after appendicetomy, in order to rationalize future use of this modality. METHODS We retrospectively audited all cases of acute appendicitis over a 4-year period in a single pediatric hospital, recording demographics, surgical approach, pathology, analgesia use, pain scores, and duration of PCA. We preplanned subgroup analyses for surgical approach, pathology, and intraoperative nonsteroidal anti-inflammatory drug (NSAID) administration. We subsequently identified a patient subgroup who were unlikely to require PCA and conducted a (2 months) prospective audit of such patients (uncomplicated appendicitis with intraoperative NSAID) having non-PCA (oral) analgesia. RESULTS Of the 649 patients undergoing appendicectomy for acute appendicitis, 85% were prescribed an opioid PCA, 8% received an opioid infusion (younger patients), and 7% received neither PCA nor infusion. Of the 541 bolus only PCA patients, 49% had laparoscopic surgery, 36% had complicated appendicitis, and 49% received intraoperative NSAID (diclofenac). Mean (SD) duration of PCA was shorter with uncomplicated vs complicated appendicitis (21.9 ± 10.7 vs 32.8 ± 21.1 h, P < 0.001, difference in means [95% CI]: 10.9 [7.7-14.1]), and with intraoperative NSAID (23.2 ± 14.4 vs 28.4 ± 17.4 h, P < 0.001, difference in means [95% CI]: 5.2 [2.5-7.9]). There was no difference in the time to PCA cessation between laparoscopic and open approach. Morphine consumption and pain scores were lower in the early postoperative period for those patients receiving intraoperative NSAID. In the prospective audit, 44 of 69 patients had uncomplicated appendicitis. Thirty-eight of these were prescribed oral analgesia and none required any parenteral opioid or acute pain service intervention postoperatively. Parental satisfaction level was high (>90%) with oral analgesia. CONCLUSIONS It is feasible that children with uncomplicated appendicitis given intraoperative NSAID can be successfully managed without PCA.
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Affiliation(s)
- Rowan Ousley
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Laura L Burgoyne
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Nicola R Crowley
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia.,Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - David Costi
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
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Frongia G, Mehrabi A, Ziebell L, Schenk JP, Günther P. Predicting Postoperative Complications After Pediatric Perforated Appendicitis. J INVEST SURG 2016; 29:185-94. [PMID: 26822038 DOI: 10.3109/08941939.2015.1114690] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Assessment of risk factors for postoperative complications following surgical treatment of pediatric perforated appendicitis (PA) is necessary to identify those patients in need of closer monitoring. In this study, we have investigated the impact of different risk factors on the occurrence of complications after an appendectomy in children with PA. MATERIAL AND METHODS The study was a retrospective, single-centre analysis of all pediatric PA conducted over a 10-year period. Preoperative clinical and laboratory results, intraoperative findings, and postoperative complications were analyzed. Risk factors were defined and a risk score was determined for postoperative complications and reinterventions. RESULTS Surgical treatment for appendicitis was performed in 840 pediatric patients during the observation period. 163 of the included patients were diagnosed with PA (mean age 8.9 ± 3.6 years). 19 (11.7%) patients developed postoperative complications, 17 (10.4%) of which required complication-related intervention. We identified five predictors of postoperative complications: the C-related protein value at admission, purulent peritonitis, open appendectomy (primary, secondary, or converted), placement of an abdominal drain, and administration of antibiotics not compliant to results from the subsequent antibiogram. The determined risk score was significantly higher in the complication group (p < .0001) and reintervention group (p < .001). CONCLUSIONS Postoperative complications following pediatric PA can be predicted using specific preoperative, intraoperative, and postoperative risk factors. In the high-risk group, an active prevention, detection, and intervention of any occurring complication is necessary and we present a new specific pediatric risk score to define patients at risk for complications.
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Affiliation(s)
- G Frongia
- a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery
| | - A Mehrabi
- b Department of General , Visceral and Transplantation Surgery
| | - L Ziebell
- a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery
| | - J P Schenk
- c Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology , University Hospital of Heidelberg , Heidelberg , Germany
| | - P Günther
- a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery
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Sesia SB, Berger E, Holland-Cunz S, Mayr J, Häcker FM. Laparoscopy-Assisted Single-Port Appendectomy in Children: Safe Alternative also for Perforated Appendicitis? Medicine (Baltimore) 2015; 94:e2289. [PMID: 26683962 PMCID: PMC5058934 DOI: 10.1097/md.0000000000002289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Because of its low complication rate, favorable safety, cost-effectiveness, and technical ease, mono-instrumental, laparoscopy-assisted single-port appendectomy (SPA) has been the standard therapy for appendicitis in our department since its introduction 10 years ago. We report our experience with this technique and compare its outcome to open appendectomy (OA). The records of all children who underwent appendectomy at our institution over a period of 8 years were analyzed retrospectively. Patient baseline data, markers of inflammation, operative time, length of hospital stay, complication rate according to the classification of Clavien-Dindo, and histologic grading were assessed to compare the 2 surgical techniques (SPA and OA). The chi square test, the Student's t test and the Wilcoxon-Mann-Whitney test were used to analyze the data and the comparisons of the mean values. A P value < 0.05 was considered significant. Overall, 975 patients were included in the study. A total of 555 children had undergone SPA and 420 had been treated by OA. Median operative time of SPA was longer than that of OA (60.8 min vs 57.4 min; P < 0.05). Length of hospital stay after SPA was shorter than after OA (4.4 days and 5.9 days, respectively; P < 0.001). The overall complication rate was lower for SPA than that for OA (4.0% vs 5.7%), but the difference of complications for SPA and OA was not statistically significant (P < 0.22). SPA was successfully performed in 85.9% of children. In 53.8% of patients with perforated appendicitis, no conversion was required. In the group of children with perforated appendicitis, the complication rate of ∼20% was independent of the surgical technique applied. With respect to operative time, length of hospital stay, and postoperative complication rate, SPA is not inferior to OA. SPA is safe and efficient, even in the management of perforated appendicitis.
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Affiliation(s)
- Sergio B Sesia
- From the Department of Pediatric Surgery, University Children's Hospital of Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland
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Laparoscopic approach to appendectomy reduces the incidence of short- and long-term post-operative bowel obstruction: systematic review and pooled analysis. J Gastrointest Surg 2014; 18:1683-92. [PMID: 24950775 DOI: 10.1007/s11605-014-2572-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 06/08/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this meta-analysis was to determine the effect of laparoscopic appendectomy (LA) compared to open appendectomy (OA) on short-term and long-term post-operative bowel obstruction. METHODS Medline, Embase, trial registries, conference proceedings and reference lists were searched. Subset analysis was performed for paediatric patients, patients who presented with perforated appendicitis and studies with long-term follow-up and surveillance for bowel obstruction and with surgery for bowel obstruction. RESULTS Overall, 29 studies comprising 159,729 patients (60,875 LA versus 98,854 OA) were included. LA was associated with a significant reduction in the incidence of post-operative bowel obstruction in the general population (pooled odds ratio (POR) = 0.43 [95 %C.I. 0.3-0.63]). Subset analysis demonstrated that LA significantly reduced the incidence of post-operative bowel obstruction in paediatric patients (POR = 0.48 [95 %C.I. 0.3-0.78]) and patients with perforated appendicitis (POR = 0.44 [95 %C.I. 0.26-0.74]). Furthermore, LA was associated with a significantly reduced incidence of long-term bowel obstruction (POR = 0.33 [95 %C.I. 0.19-0.56]) and bowel obstruction requiring surgery (POR = 0.31 [95 %C.I. 0.2-0.48]). DISCUSSIONS This present meta-analysis provides evidence to clearly demonstrate the benefits of a laparoscopic approach to appendectomy as reflected by a reduction in short- and long-term adhesive bowel obstruction. Important future areas for assessment include the influence of surgical approach on long-term quality of life following appendectomy.
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Ohno Y. Role of the transumbilical laparoscopic-assisted single-channel, single-port procedure in an interval appendectomy for pediatric mass-forming appendicitis: a preliminary retrospective analysis. Asian J Endosc Surg 2014; 7:232-6. [PMID: 24861142 DOI: 10.1111/ases.12111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 03/06/2014] [Accepted: 04/06/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION A transumbilical laparoscopic-assisted single-channel, single-port procedure was introduced during laparoscopic interval appendectomy for mass-forming appendicitis in children. The aim of this study was to evaluate the results of the original laparoscopic interval appendectomy. METHODS This study analyzed 31 children who underwent laparoscopic interval appendectomy using a single-channel, single-port procedure. The appendectomy was usually planned 8-12 weeks following initial conservative treatment. The procedure was a single-channel surgery using a 12-mm single port. Both a 5-mm telescope and grasper were inserted simultaneously into the single channel. The grasper held the appendix, and an extracorporeal appendectomy was performed. RESULTS Appendectomy was planned for 29 patients, as 2 patients deviated from the protocol. The procedure was successful in 21 patients (72.4%). An accessory port was necessary in eight patients, two of whom successfully underwent laparoscopic surgery; the remaining six were converted to open appendectomy. The average length of surgery was 43 min in the single-channel, single-port procedure. No postoperative complications occurred in any patient. CONCLUSION The single-channel, single-port procedure was successfully performed in over 70% of the patients. This preliminary retrospective analysis indicates that the procedure is safe and potentially beneficial in children with mass-forming appendicitis who require laparoscopic interval appendectomy.
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Affiliation(s)
- Yasuharu Ohno
- Department of Surgery, Oita Children's Hospital, Oita, Japan; Department of Pediatric Surgery, Saitama Medical University, Iruma, Japan
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Laparoscopic appendectomy in children: experience in a single centre in chittagong, bangladesh. Minim Invasive Surg 2014; 2014:125174. [PMID: 24738029 PMCID: PMC3967814 DOI: 10.1155/2014/125174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 01/17/2014] [Accepted: 02/09/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Since the latter half of 1980s laparoscopy has become a well accepted
modality in children in many surgical procedures including appendectomy. We present here the experience of laparoscopic appendectomy in children in a tertiary care hospital in Bangladesh. Subjects & Methods. From October 7, 2005 to July 31, 2012, 1809 laparoscopic
appendectomies were performed. Laparoscopy was performed in all the cases using 3
ports. For difficult and adherent cases submucosal appendectomy was performed. Feeding was allowed 6 h after surgery and the majority was discharged on the first
postoperative day. The age, sex, operative techniques, operative findings, operative
time, hospital stay, outcome, and complications were evaluated in this retrospective
study. Results. Mean age was 8.17 ± 3.28 years and 69% were males. Fifteen percent were
complicated appendicitis, 8 cases needed conversion, and 27 cases were done by
submucosal technique. Mean operating time was 39.8 ± 14.2 minutes and mean
postoperative hospital stay was 1.91 days. About 5% cases had postoperative
complications including 4 intra-abdominal abscesses. Conclusions. Laparoscopic appendectomy is a safe procedure in children even in
complicated cases.
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Current status of minimal access surgery in children. APOLLO MEDICINE 2013. [DOI: 10.1016/j.apme.2013.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chang HK, Han SJ, Choi SH, Oh JT. Feasibility of a laparoscopic approach for generalized peritonitis from perforated appendicitis in children. Yonsei Med J 2013; 54:1478-83. [PMID: 24142654 PMCID: PMC3809857 DOI: 10.3349/ymj.2013.54.6.1478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study evaluated the feasibility of a laparoscopic approach in children with generalized peritonitis secondary to perforated appendicitis. MATERIALS AND METHODS We retrospectively analyzed the medical records of patients who underwent laparoscopic appendectomy with drainage for generalized peritonitis secondary to perforated appendicitis at our hospital between September 2001 and April 2012. Laparoscopic outcomes were compared with outcomes of an open method for perforated appendicitis. RESULTS Ninety-nine patients underwent laparoscopic appendectomy (LA) for generalized peritonitis from perforated appendicitis, and 87 patients underwent open appendectomy (OA) for perforated appendicitis. Wound infection was more common in the OA group (12.6%) than in the LA group (4.0%; p=0.032). The incidence of intestinal obstruction during long-term follow-up was significantly higher in the OA group (4.6% vs. 0.0% in the LA group; p=0.046). LA was possible in most patients for whom LA was attempted, with a conversion rate of 10.8%. Conversion to OA was affected by the preoperative duration of symptoms and the occurrence of intraoperative complications. CONCLUSION LA is feasible for use in children with generalized peritonitis from perforated appendicitis, with reasonable open conversion and perioperative complication rates comparable to those of the OA group.
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Affiliation(s)
- Hye Kyung Chang
- Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Nataraja RM, Loukogeorgakis SP, Sherwood WJ, Clarke SA, Haddad MJ. The Incidence of Intraabdominal Abscess Formation Following Laparoscopic Appendicectomy in Children: A Systematic Review and Meta-analysis. J Laparoendosc Adv Surg Tech A 2013; 23:795-802. [DOI: 10.1089/lap.2012.0522] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Ramesh M. Nataraja
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
| | - Stavros P. Loukogeorgakis
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
| | - William J. Sherwood
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
| | - Simon A. Clarke
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
| | - Munther J. Haddad
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
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Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Curr Probl Surg 2013; 50:54-86. [PMID: 23374326 DOI: 10.1067/j.cpsurg.2012.10.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Esposito C, Calvo AI, Castagnetti M, Alicchio F, Suarez C, Giurin I, Settimi A. Open versus laparoscopic appendectomy in the pediatric population: a literature review and analysis of complications. J Laparoendosc Adv Surg Tech A 2013; 22:834-9. [PMID: 23039707 DOI: 10.1089/lap.2011.0492] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study aims to compare the results of laparoscopic and open appendectomy (LA and OA, respectively) in a pediatric population with particular attention to complications analysis. SUBJECTS AND METHODS A literature search was performed using Medline, Cochrane, Embase, Sci Search, Lilacs, and PubMed databases on all studies published during the 14-year interval of 1997-2010. Comparative studies of LA versus OA in the pediatric population were included in these studies. Data concerning operative time, length of hospital stay, postoperative complications, postoperative pain, and surgical trauma were recorded. RESULTS We recorded 52 studies, but 26 of these were excluded from our analysis because they were neither relevant nor related to the adolescent population. The 26 studies analyzed showed a population of 123,628 children and adolescents (ages 0-18 years) who underwent appendectomy by laparoscopic (LA, 42,213 [34.1%]) and open (OA, 81,415 [65.9%]) techniques. Our analysis showed that patients undergoing LA presented a lower incidence of surgical wound infection, lower incidence of postoperative ileus, a lower use of analgesics in the postoperative period, an earlier resumption of normal diet, a shorter hospitalization, and a more rapid recovery to resume normal activities compared with patients undergoing OA. This study, comparing LA versus OA in children, failed to identify any major difference between the two techniques in terms of formation of intra-abdominal abscesses. As for operative time, our analysis showed globally a significant reduced operative time in OA versus LA in complicated appendicitis, but in simple appendicitis the operative time seems to be the same. CONCLUSIONS Our analysis of the literature showed that the LA technique presents several advantages compared with the OA technique. For this reason, if a child is hospitalized today for appendicitis treatment in a pediatric center where the laparoscopic approach is unavailable, he or she should be placed on antibiotics and transferred to a center that offers the laparoscopic approach.
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Affiliation(s)
- Ciro Esposito
- Department of Pediatrics, Federico II University of Naples, Via Pansini 5, Naples, Italy.
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Vahdad MR, Troebs RB, Nissen M, Burkhardt LB, Hardwig S, Cernaianu G. Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendectomy. J Pediatr Surg 2013; 48:555-61. [PMID: 23480912 DOI: 10.1016/j.jpedsurg.2012.07.066] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 07/23/2012] [Accepted: 07/27/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children with perforated appendicitis (PA). METHODS We reviewed the medical files of 221 children who underwent LA (n=75), OA (n=122), and conversion (CO) (n=24), comparing duration of operation, re-admissions, re-operations, intra-abdominal abscesses (IAA), and wound infections. RESULTS Compared to OA, LA resulted in fewer re-admissions (1.3% vs. 12.3%; P=.006), fewer re-operations (4% vs. 17.2%; P=.006), and fewer wound infections (0% vs. 11.5%; P=.001). No differences in the duration of operation (72.9 ± 23.0 min vs. 77.7 ± 48.0 min; P=.392) or IAA (4% vs. 11.5%; P=.114) were observed. Compared to LA, CO had more complications. CONCLUSIONS We report that LA is superior to OA with regard to incidence of re-admission, re-operation, and wound infection.
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Affiliation(s)
- Mohammad Reza Vahdad
- Department of Pediatric Surgery, Marienhospital-Kinderchirurgische Klinik der Ruhr-Universität Bochum, Widumerstr. 8, 44627 Herne, Germany.
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Laparoscopic versus open appendectomy in the management of all stages of acute appendicitis in children: a retrospective study. Pediatr Neonatol 2012; 53:289-94. [PMID: 23084720 DOI: 10.1016/j.pedneo.2012.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 10/04/2011] [Accepted: 11/03/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We conducted this study in order to evaluate whether laparoscopic appendectomy was an alternative therapeutic tool to open appendectomy for all stages of pediatric appendicitis. MATERIALS AND METHODS Between January 2000 and November 2004, the charts of 177 children who underwent appendectomy by a single surgeon were reviewed. The patients were divided into open and laparoscopic appendectomy groups. Each group was subdivided into three stages: simple appendicitis, perforated appendicitis, and appendicitis with abscess. The age, gender, white blood cell count, absolute neutrophil count, C-reactive protein, operating time, duration of postoperative hospital stay, minor and major complications, and use of intravenous analgesia were recorded. Fisher's exact and Student's t-test were used for statistical analysis. RESULTS There were fewer minor complications (9/32 vs. 0/20, p = 0.009) in perforated appendicitis stage and fewer major complications (9/26 vs. 1/24, p = 0.011) in appendicitis with abscess stage between open and laparoscopic appendectomy group. But surgery for each laparoscopic appendectomy group took longer to perform than for the corresponding open appendectomy group in each stage (p < 0.05). There was no significant difference in other data between corresponding groups in each stage. CONCLUSION Laparoscopic appendectomy may be considered a better alternative to open appendectomy for children with perforated appendicitis and appendicitis with abscess.
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Comparison of outcomes of laparoscopic versus open appendectomy in children: data from the Nationwide Inpatient Sample (NIS), 2006-2008. World J Surg 2012; 36:573-8. [PMID: 22270985 DOI: 10.1007/s00268-011-1417-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The benefits of laparoscopic appendectomy (LA) remain undefined as compared to open appendectomy (OA) in children, particularly in cases of perforated appendicitis. The purpose of the present study was to evaluate the outcomes of LA versus OA in perforated and nonperforated appendicitis in children. METHODS Using the Nationwide Inpatient Sample database, we evaluated the clinical data of children (<18 years old) who underwent LA and OA from 2006 to 2008. Incidental and elective appendectomies were excluded. RESULTS A total of 212,958 children underwent urgent appendectomy in the United States during these years. The overall rate of perforated appendicitis was 27.7, and 56.9% of all cases were performed laparoscopically. In nonperforated cases, LA was associated with comparable overall complication rate (LA: 2.56 vs. OA: 2.66%; p = 0.26), shorter length of hospital stay (LOS, LA: 1.6 vs. OA: 2.0 days; p < 0.01), comparable mortality (LA: 0.01 vs. OA: 0.02%; p = 0.25); and higher hospital charges (LA: $20,328 vs. OA: $16,830; p < 0.01) compared to OA. In perforated cases, LA had a lower overall complication rate (LA: 16.03 vs. OA: 18.07%; p < 0.01), shorter LOS (LA: 5.1 vs. OA: 5.8 days; p < 0.01), lower mortality (LA: 0.0% versus OA: 0.06%; p < 0.01), and similar hospital charges (LA: $33,361 versus OA: $33, 662; p = 0.71) compared to OA. CONCLUSIONS LA is safe in children with acute perforated and nonperforated appendicitis, and is associated with shorter hospital stay than OA. The laparoscopic approach is associated with lower morbidity and mortality in perforated cases. However, in nonperforated cases, these benefits are modest and are associated with higher hospital charges.
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Davila D, Russek K, Franklin ME. Laparoscopic appendectomy: vascular control of the appendicular artery using monopolar cauterization versus clips. J Laparoendosc Adv Surg Tech A 2011; 22:165-7. [PMID: 22145596 DOI: 10.1089/lap.2010.0312] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Laparoscopic appendectomy is now the standard of treatment for acute appendicitis in medical centers where advanced minimally invasive surgery is performed, and it has become the standard of care in our institution. The techniques for laparoscopic appendectomy are widely described in surgical textbooks, but the vascular control of the appendicular artery is diverse. In this article, we compare the benefits and possible complications of different techniques to obtain vascular control. SUBJECTS AND METHODS This is a retrospective study of prospectively collected data including all cases of laparoscopic appendectomy from September 1990 to August 2009. Here we describe the different methods used, and we present a large series of 729 cases of laparoscopic appendectomy. In the majority of the cases the diagnosis was acute appendicitis followed by laparoscopic appendectomy. In only 124 cases was an incidental appendectomy performed associated with another laparoscopic procedure. RESULTS In 350 cases (48%) monopolar cauterization was used to obtain vascular control of the appendicular artery. In the other 379 cases the artery was either clipped or stapled (52%). There were no postoperative complications reported. There was no difference in patient outcome with either approach to obtain adequate vascular control. CONCLUSIONS The vascular control of the appendicular artery obtained with monopolar cautery is a safe, fast, and economic approach easily done during a laparoscopic or needlescopic appendectomy with no increased risks or complications.
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Affiliation(s)
- Daniel Davila
- Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico.
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Shindholimath VV, Thinakaran K, Rao TN, Veerappa YV. Laparoscopic management of appendicular mass. J Minim Access Surg 2011; 7:136-40. [PMID: 21523236 PMCID: PMC3078476 DOI: 10.4103/0972-9941.78345] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 10/13/2010] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Laparoscopic appendectomy is becoming the preferred technique for treating acute appendicitis. However, its role in the treatment of complicated appendicitis is controversial. This study was undertaken to assess the feasibility of laparoscopic appendectomy for appendicular mass. MATERIALS AND METHODS A retrospective review was performed of all the patients who were treated laparoscopically for appendicular mass from March 2007 to October 2009. SETTING Tertiary care hospital. RESULTS A total of 120 patients were treated for appendicitis. A retrospective review of the patients' records demonstrated that 19 patients (15.8%) had appendicular mass at the time of admission. The average operative time was 95 minutes (range 45-140 minutes). Pathological evidence of appendicitis was present in all the patients. The average length of hospital stay was six days (rang 6-9 days). Three patients (15.7%) had post- operative complications. Two patients developed wound infections and one patient was re-admitted with pain and a lump below the umbilical port. CONCLUSION The findings suggest that laparoscopic appendectomy is feasible in patients with appendicular mass. The authors propose a prospective, randomized trial to verify this finding.
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Affiliation(s)
- Vishwanath V Shindholimath
- Department of Surgery, PES Institute of Medical Sciences and Research, Kuppam, 517 425, District Chittoor, Andhra Pradesh, India
| | - K Thinakaran
- Department of Surgery, PES Institute of Medical Sciences and Research, Kuppam, 517 425, District Chittoor, Andhra Pradesh, India
| | - T Narayana Rao
- Department of Surgery, PES Institute of Medical Sciences and Research, Kuppam, 517 425, District Chittoor, Andhra Pradesh, India
| | - Yenni Veerabhadrappa Veerappa
- Department of Pathology, PES Institute of Medical Sciences and Research, Kuppam, 517 425, District Chittoor, Andhra Pradesh, India
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Abstract
PURPOSE Optimal surgical approach for advanced pediatric appendicectomy remains controversial. We compare the open versus the laparoscopic approach. METHODS Retrospective case notes review of children operated on for advanced appendicitis between January 2005 and July 2006 was undertaken for length of hospital stay, operating time, wound complications, need for further surgery, and hospital readmission. RESULTS Forty children were included, 17 were treated with open approach and 23 with laparoscopic approach. There was no conversion from laparoscopic to open approach. Overall complication rate, length of hospital stay, and need for further surgery were similar in both groups. The mean operative time was longer in the laparoscopic group. Wound complications occurred more in the open group. Readmission for gastrointestinal obstruction was noted in the laparoscopic group. CONCLUSIONS Laparoscopic approach is safe for advanced appendicitis in children. The outcomes are comparable in both study groups.
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Muensterer OJ, Puga Nougues C, Adibe OO, Amin SR, Georgeson KE, Harmon CM. Appendectomy using single-incision pediatric endosurgery for acute and perforated appendicitis. Surg Endosc 2010; 24:3201-4. [PMID: 20490556 DOI: 10.1007/s00464-010-1115-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 05/03/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single-incision pediatric endosurgical (SIPES) appendectomy has been reported in few pediatric surgical centers. We have adopted the technique recently and have offered it to all patients in whom appendectomy was indicated. The purpose of this study was to report our experience with SIPES appendectomy for acute appendicitis, perforated appendicitis, and interval appendectomy, and to compare the results with those from patients who underwent conventional laparoscopic appendectomy 1 year previously. METHODS After IRB approval, data on all SIPES appendectomies performed in our hospital were prospectively collected, including operative time, intra- and postoperative complications, conversion rate, blood loss, and hospital length of stay. Cases were stratified into three categories: acute appendicitis, perforated appendicitis, and interval appendectomy. They were compared to patients operated on in 2007 using conventional laparoscopic (three-trocar) appendectomy. RESULTS During the study period, 75 SIPES appendectomies were undertaken. Mean age was 11 years (range = 2-19 years) and mean weight was 45 kg (range = 12-132 kg). All SIPES appendectomies were completed laparoscopically, and additional trocars were placed in 20% of cases. SIPES interval appendectomies took the longest and had the highest conversion rate (33%). Follow-up data was available in 63 patients (82%) at a median of 3 weeks. There were three wound infections in the SIPES group (4%) and one in the 151 control patients. Compared to historic controls, operative time was shorter with SIPES compared to conventional laparoscopy for acute appendicitis (37 ± 12.3 vs. 44.1 ± 20.3 min, p = 0.01, 95% CI = 32-42 min). CONCLUSION SIPES appendectomy is a very good alternative to the conventional laparoscopic approach, especially for acute appendicitis. It is technically more challenging for perforated appendicitis and interval appendectomy. Yet, with appropriate consideration and skill, scarless appendectomy is achievable.
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Affiliation(s)
- Oliver J Muensterer
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South, ACC 300, Birmingham, AL 35233, USA.
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Bensard DD, Hendrickson RJ, Fyffe CJ, Careskey JM, Azizkhan RG. Early discharge following laparoscopic appendectomy in children utilizing an evidence-based clinical pathway. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S81-6. [PMID: 19025474 DOI: 10.1089/lap.2008.0165.supp] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The utility of laparoscopic appendectomy (LA) in children remains controversial. The determination of the efficacy of LA in children is complicated by variable postoperative management, duration of antibiotics,and criteria for discharge. The aim of this study was to examine the results of a commitment to LA and the concurrent implementation of an evidence-based clinical pathway (CP) for management appendicitis in a children's hospital. METHODS With institutional review board approval, all children presenting with appendicitis (n = 72; age =10.6 +/- 0.1 years) were offered LA and management directed by CP. Data were accrued prospectively for 12 consecutive months (May 2006 to April 2007) and analysis performed at 15 months. Data are reported as the mean +/- standard error of the mean. RESULTS Children were stratified based on the operative findings: group one - acute 41; group two-suppurative=11; and group 3-gangrenous or perforated 20. Duration of hospital stay differed between the groups:group one= 26 +/- 0.3 hours; group 2 =48 +/- 3 hours; group 3= 127 +/- 6 hours (P <0.05). No patients in groups one or two suffered a complication or were readmitted following discharge. Two patients in group 3 (10%)were readmitted and treated with antibiotic therapy alone. Overall, 66% of the children with acute appendicitis(27/41) and 27% with suppurative appendicitis (3/11) were discharged within 24 hours of admission. Discharge by 24 hours in groups 1 and 2 was not influenced by age, gender, or time of operation (before or after 7 PM). CONCLUSIONS The commitment to LA and use of CP resulted in discharge within 24 hours in 2 of 3 of children with acute appendicitis without readmission or complications being observed. Early discharge was not influenced by age, gender, or time of admission. For advanced appendicitis, length of hospital stay, determined by clinical parameters, resulted in a low rate of complication or readmission.
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Affiliation(s)
- Denis D Bensard
- Department of Pediatric Surgery, The Peyton Manning Children's Hospital at St. Vincent, Indianapolis, Indiana, USA.
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IPEG guidelines for appendectomy. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:vii-ix. [PMID: 19371152 DOI: 10.1089/lap.2009.9983.supp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Malik AM, Talpur AH, Laghari AA. Video-assisted laparoscopic extracorporeal appendectomy versus open appendectomy. J Laparoendosc Adv Surg Tech A 2009; 19:355-9. [PMID: 19397395 DOI: 10.1089/lap.2008.0303] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Laparoscopic appendectomy (LA) is categorized into intracorporeal appendectomy (ICA) and video-assisted extracorporeal appendectomy (VAECA). This study is conducted to compare feasibility and effectiveness of video-assisted extracorporeal appendectomy (VAECA) with open appendectomy (OA). PATIENTS AND METHODS This was a comparative descriptive study conducted at the Department of Surgery of Liaquat University of Medical and Health Sciences (Jamshoro, Pakistan) from June 2003 to November 2007. Two hundred and eighty-three patients of acute appendicitis were included and categorized into two groups: A and B. Group A included 150 (53%) patients operated on by the OA technique, while group B included 133 (47%) patients in whom VAECA was performed. VAECA was accomplished through three ports in the majority of patients (89%), while a few cases (11%) were completed by two ports only. Patients below 10 years of age and with suspected appendicular mass were excluded from the study. Both operative techniques and their merits and demerits were explained to all the patients and, depending upon their choice or by a simple flip of a coin, they were operated on by either of the techniques. A well-informed written consent was also taken from every patient. The results of both the groups were collected on a proforma and were compared in terms of cosmesis, total operative time, operative and postoperative complications, and total duration of hospital stay. RESULTS The mean operating time was much shorter in group B (p < 0.001), compared to group A patients. The incidence of postoperative infection was comparatively higher in OA, compared to VAECA. The rate of operative complications (p < 0.001), postoperative complications (p < 0.01), and duration of hospital stay (p < 0.001) were all significantly lower in the VAECA group. Cosmetic results were excellent in VAECA, compared to OA, as assessed by length of incision and the postoperative scar formation. CONCLUSION VAECA can be a good alternate option in simple cases without much adhesions or mass formation.
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Affiliation(s)
- Arshad M Malik
- Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
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Kaselas C, Molinaro F, Lacreuse I, Becmeur F. Postoperative bowel obstruction after laparoscopic and open appendectomy in children: a 15-year experience. J Pediatr Surg 2009; 44:1581-5. [PMID: 19635309 DOI: 10.1016/j.jpedsurg.2008.11.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2008] [Revised: 11/18/2008] [Accepted: 11/19/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of the study was to determine and evaluate the incidence of postoperative bowel obstruction (PBO) after laparoscopic and open appendectomy in children. MATERIAL AND METHODS The medical files of children who have undergone an appendectomy, either via the laparoscopic or open approach, at our department from 1992 until 2007 were reviewed. Collected data included age at appendectomy, initial surgical approach, time interval to PBO, and type of definitive treatment. The incidences of PBO after laparoscopic and open appendectomy were compared with the chi(2) analysis. RESULTS From the 1684 children who were found, 1371 had nonperforated appendicitis and 313 had perforated appendicitis. Laparoscopic appendectomy was performed in 954 patients of the nonperforated group and in 221 of the perforated group. Open appendectomy was performed in 417 and 92 patients of the 2 groups, respectively. Overall, the incidence of PBO development was 2.2%. In the laparoscopic appendectomy population, a significantly low incidence of 1.19% of PBO development was detected, compared with the 4.51% of the open appendectomy group (P < .0001). CONCLUSION Laparoscopic appendectomy diminishes the potential of PBO development. The overall incidence of PBO is not related to the severity of the disease but only to the initial operative approach.
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Affiliation(s)
- Christos Kaselas
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 67098 Strasbourg Cedex, France.
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Laparoscopic versus open appendectomy: a prospective randomized comparison. Surg Endosc 2009; 24:266-9. [PMID: 19517167 DOI: 10.1007/s00464-009-0563-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 04/18/2009] [Accepted: 05/14/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND Whether laparoscopy offers a benefit over open surgery in the management of acute appendicitis or not remains a subject of controversy despite the publication of numerous randomized studies. This study aimed to compare laparoscopic appendectomy (LA) with open appendectomy (OA) and to ascertain its therapeutic benefit. METHODS Adult patients older than 14 years presenting with signs and symptoms suggestive of acute appendicitis were randomized to undergo either LA or OA from January 2006 to December 2007. Comparisons were based on operating time, time until return to a general diet, time until return to normal activity and work, length of hospital stay, billed charges, and postoperative complications. RESULTS The study enrolled 220 patients: 108 to undergo OA and 112 to undergo LA. The groups were similar in terms of clinicopathologic characteristics. The operating time seemed to be shorter for the OA patients than for the LA patients, but the difference was not significant (LA, 30 +/- 15.2 min vs. OA, 28.7 +/- 16.3 min; p > 0.05). The hospital stay of 4.1 +/- 1.5 days for the LA group and 7.2 +/- 1.7 days for the OA group, and the difference was statistically significant (p < 0.05). Laparoscopic appendectomy remained associated with a shorter time until return to a general diet (LA, 20.2 +/- 12.4 h vs. OA, 36.5 +/- 10 h; p < 0.05), to normal activity (LA, 9.1 +/- 4.2 days vs. OA, 13.7 +/- 5.8 days; p < 0.05), and to work (LA, 21.2 +/- 3.5 days vs. OA, 27.7 +/- 4.9 days; p < 0.05). The billed charges appeared to be higher for LA (LA, 5,720.3 +/- 115.7 yuan vs. OA, 5,310 +/- 575.4 yuan), but this difference failed to be clinically important or statistically significant (p > 0.05). Wound infections were more common after OA (n = 14) than after LA (n = 0) (p < 0.05). Intraabdominal abscesses occurred for two patients in the LA group and nine patients in the OA group (p < 0.05). Postoperative ileus occurred with frequencies of 0% in the LA group and 7.4% in the OA group (p < 0.05). The rate for overall complications was significantly lower in the LA group. CONCLUSION Laparoscopic appendectomy is a useful tool in the treatment of acute appendicitis. Its advantages lie in its minimal invasiveness, its better cosmetic outcome, its lower rate of complications based on surgical expertise and state-of-the-art equipment. It can be recommended as an adoptable method for the routine patient with appendicitis.
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Bensard DD, Hendrickson RJ, Fyffe CJ, Careskey JM, Azizkhan RG. Early discharge following laparoscopic appendectomy in children utilizing an evidence-based clinical pathway. J Laparoendosc Adv Surg Tech A 2008. [PMID: 19025474 DOI: 10.1089/lap.2008.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The utility of laparoscopic appendectomy (LA) in children remains controversial. The determination of the efficacy of LA in children is complicated by variable postoperative management, duration of antibiotics,and criteria for discharge. The aim of this study was to examine the results of a commitment to LA and the concurrent implementation of an evidence-based clinical pathway (CP) for management appendicitis in a children's hospital. METHODS With institutional review board approval, all children presenting with appendicitis (n = 72; age =10.6 +/- 0.1 years) were offered LA and management directed by CP. Data were accrued prospectively for 12 consecutive months (May 2006 to April 2007) and analysis performed at 15 months. Data are reported as the mean +/- standard error of the mean. RESULTS Children were stratified based on the operative findings: group one - acute 41; group two-suppurative=11; and group 3-gangrenous or perforated 20. Duration of hospital stay differed between the groups:group one= 26 +/- 0.3 hours; group 2 =48 +/- 3 hours; group 3= 127 +/- 6 hours (P <0.05). No patients in groups one or two suffered a complication or were readmitted following discharge. Two patients in group 3 (10%)were readmitted and treated with antibiotic therapy alone. Overall, 66% of the children with acute appendicitis(27/41) and 27% with suppurative appendicitis (3/11) were discharged within 24 hours of admission. Discharge by 24 hours in groups 1 and 2 was not influenced by age, gender, or time of operation (before or after 7 PM). CONCLUSIONS The commitment to LA and use of CP resulted in discharge within 24 hours in 2 of 3 of children with acute appendicitis without readmission or complications being observed. Early discharge was not influenced by age, gender, or time of admission. For advanced appendicitis, length of hospital stay, determined by clinical parameters, resulted in a low rate of complication or readmission.
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Affiliation(s)
- Denis D Bensard
- Department of Pediatric Surgery, The Peyton Manning Children's Hospital at St. Vincent, Indianapolis, Indiana, USA.
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Faiz O, Blackburn SC, Clark J, Bottle A, Curry JI, Farrands P, Aylin P. Laparoscopic and conventional appendicectomy in children: outcomes in English hospitals between 1996 and 2006. Pediatr Surg Int 2008; 24:1223-7. [PMID: 18791723 DOI: 10.1007/s00383-008-2247-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic appendicectomy is increasingly used in children. This national retrospective study compared outcomes of paediatric open and laparoscopic appendicectomy. METHODS Length of stay, readmission rates and mortality in children undergoing open and laparoscopic appendicectomy in English NHS Trusts between 1 April 1996 and 31 March 2006 were compared. Procedures coded as emergency excision of appendix (OPCS-4 H01) on the Hospital Episode Statistics (HES) database in patients less than 15 years of age were included. Multivariate analysis was used to identify independent predictors of length of hospital stay and mortality. RESULTS Eighty-nine thousand, four-hundred and ninety-seven (89,497) appendicectomies were studied; of which, 2,689 (3%) were performed laparoscopically. The percentage of laparoscopic cases rose from 0.6 to 8.4% between 1996 and 2006 (Pearson's r = 0.954, P < 0.001). Length of stay (median 3, interquartile range 2 days, P = 0.068) and 28-day readmission rates were similar (6.3 vs. 7.2%, respectively; P = 0.072) between groups. No independent hospital stay advantage for laparoscopy was observed (P = 0.121). No difference in 30-day mortality (P = 0.986) or 365-day mortality (P = 0.598) was demonstrated. CONCLUSION Hospital stay, readmission rates and mortality are similar following laparoscopic and open appendicectomy in children.
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Affiliation(s)
- O Faiz
- Department of Biosurgery and Surgical Technology, St Mary's Hospital, Imperial College, Praed Street, London, W21NY, UK.
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Prevention of intra-abdominal abscess following laparoscopic appendicectomy for perforated appendicitis: A prospective study. Int J Surg 2008; 6:374-7. [PMID: 18789777 DOI: 10.1016/j.ijsu.2008.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 06/20/2008] [Indexed: 11/22/2022]
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Keckler SJ, Tsao K, Sharp SW, Ostlie DJ, Holcomb GW, St. Peter SD. Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess. J Pediatr Surg 2008; 43:977-80. [PMID: 18558168 PMCID: PMC3082429 DOI: 10.1016/j.jpedsurg.2008.02.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 02/08/2008] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial. METHODS After institutional review board approval, a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006. Continuous variables are listed with standard deviation. RESULTS There were 52 patients with a mean age of 9.0 +/- 3.9 years and weight of 34.4 +/- 18.8 kg. The mean duration of symptoms at presentation was 8.4 +/- 7.6 days. Percutaneous aspiration only was performed in 2 patients. The mean volume of fluid on initial aspiration/drain placement was 76.3 +/- 81.1 mL. The mean time to appendectomy was 61.9 +/- 25.2 days. The laparoscopic approach was used in 49 patients (94.2%), of which one was converted to an open operation. The mean length of hospitalization after interval appendectomy was 1.4 +/- 1.4 days. A recurrent abscess developed in 17.3% of the patients. Six patients (11.5%) required another drainage procedure. The mean total charge to the patients was $40,414.02. There were 4 significant drain complications (ileal perforation, colon perforation, bladder perforation, and buttock/thigh necrotizing abscess). The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy. CONCLUSIONS The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach. However, this management poses complication risks and uses considerable resources. Therefore, this strategy should be compared with early operation in a prospective trial.
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Affiliation(s)
| | | | | | | | | | - Shawn D. St. Peter
- Corresponding author. Department of Pediatric Surgery, Children’s Mercy Hospital and Clinics, Kansas City, MO 64108, USA. Tel.: +1 816 983 6465; fax: +1 816 983 6885. (S.D. St. Peter)
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Laparoscopic appendectomy for simple and complicated appendicitis in children--safe or risky procedure. Surg Laparosc Endosc Percutan Tech 2008; 18:29-32. [PMID: 18287979 DOI: 10.1097/sle.0b013e31815b2de0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to present our experience and to assess the advantages of laparoscopic appendectomy, particularly in children with perforated appendicitis. MATERIALS AND METHODS Between 1999 and 2005, 505 laparoscopic appendectomies were performed. In children aged between 2 and 18 years, number, sex, age, histologic type of appendicitis, additional surgical procedures, number and type of complications, time of procedure, and hospitalization were analyzed. RESULTS There was no need for conversion even in perforated appendicitis and in technically difficult cases. In 21 (4.16%) children in postoperative period minor complications occurred. Average operating time was 43 minutes. Average hospital stay was 2.4 days. CONCLUSIONS Laparoscopic appendectomy is good alternative for classic appendectomy, irrespective of the degree of inflammation. Accurate cleaning and rinsing of the abdominal cavity essentially decreases the quantity of complications even in cases with perforated appendicitis. This suggests the expansion of indications toward laparoscopic appendectomy in case of all children with acute appendicitis.
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Esposito C, Borzi P, Valla JS, Mekki M, Nouri A, Becmeur F, Allal H, Settimi A, Shier F, Sabin MG, Mastroianni L. Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World J Surg 2007; 31:750-5. [PMID: 17361358 DOI: 10.1007/s00268-006-0699-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM The laparoscopic treatment of paediatric appendicitis remains controversial, especially in the presence of complications. This study evaluated the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) by analysing the data from a multicentre study. METHODS The authors retrospectively reviewed a series of 2,332 appendectomies (1,506 LA and 826 OA) performed in children and adolescents (median age 8 years) in 9 different centres of paediatric surgery. For the patients operated using laparoscopy, an IN procedure was employed in 921 (61.2%), an OUT procedure in 571 (37.9%) and a MIXED procedure in 14 (0.9%). In the open surgery, a McBurney incision was adopted in 795 patients (96.4%). RESULTS Median duration of surgery was 40 minutes for LA and 45 minutes for OA. Median hospital stay was 3 days (LA) and 4.3 days (OA) in case of simple appendicitis and 5.2 days (LA) and 8.3 days (OA) in case of peritonitis. Complications were recorded in 124 LA cases (8.2%) and 65 OA cases (7.9%). The conversion rate in laparoscopy was only 1.6% (25 cases). The statistical analysis was performed using the Mann-Whitney test, and the main significant difference that emerged was the length of hospital stay, which was in favour of laparoscopy compared with open surgery (P < 0.0001). CONCLUSIONS We conclude that in clinical settings where laparoscopic surgical expertise and equipment are available and affordable, LA seems to be an effective and safe alternative to OA. Three out 9 centres participating in our survey perform LA in all patients with a suspicion of appendicitis. Our study shows that laparoscopy significantly reduces hospital stay in case of appendicitis and peritonitis and presents an extremely low conversion rate (1.6%) to open surgery. Laparoscopic transumbilical appendectomy (37.9%) in our series seems to be a simple option, even for less-skilled laparoscopic surgeons.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Magna Graecia University Catanzaro and Federico II University of Naples, Piazza degli Artisti 7/c, 80129 Naples, Italy.
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Gauderer MW. An Individualized Approach to Appendectomy in Children Based on Anatomico-Laparoscopic Findings. Am Surg 2007. [DOI: 10.1177/000313480707300817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Whether an appendectomy should be performed “open” or laparoscopically is the subject of considerable debate. This study in children was undertaken to test the hypothesis that an individualized approach, based on disease stage, body habitus, and laparoscopic findings should dictate the removal technique. Data on 108 consecutive pediatric appendectomies were prospectively recorded. Except in complex cases, a 5 mm laparoscope was inserted umbilically, the findings were evaluated, and the best removal approach was selected. Depending on the degree of inflammation and mobility, the appendix was fully delivered and resected, either through the initial umbilical trocar site or, more commonly, through a second right lower quadrant (RLQ) trocar site. The second RLQ trocar incision was enlarged for limited or full conversion to an open approach, if needed. In overweight children, three trocars and a stapler were used. Children (63 boys, 45 girls) ranged in age from 3 to 18 years (mean, 11 years). A single umbilical port was used in 16 patients with low-grade appendiceal inflammation. A two trocar, laparoscopically-assisted appendectomy was used in 63 cases. Of these 63, a limited extension of the RLQ trocar incision was necessary in 4 patients and conversion to an open incision was needed in 4 children. The three trocar technique was used 21 times. Twelve of these were cases involving obese patients. A stapler was used 13 times. Four trocars were needed once. Seven patients with complex appendicitis did not undergo laparoscopy. Twenty-nine appendices were perforated, and there were 3 complications: 2 intra-abdominal abscesses and one trocar site wound infection. Because appendiceal disease is a spectrum, and children encompass a wide range of ages and sizes, an individualized approach, based on the anatomical parameters and the clinical and laparoscopic findings, allows for an efficient, patient-specific appendectomy: single trocar for minimally inflamed appendices, two trocars for the most common types, three trocars plus a stapler for overweight children, and an “open” procedure for complex cases.
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Affiliation(s)
- Michael W.L. Gauderer
- Division of Pediatric Surgery, Children's Hospital, Greenville Hospital System, University Medical Center, Greenville, South Carolina
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Tsao KJ, St Peter SD, Valusek PA, Keckler SJ, Sharp S, Holcomb GW, Snyder CL, Ostlie DJ. Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg 2007; 42:939-42; discussion 942. [PMID: 17560198 DOI: 10.1016/j.jpedsurg.2007.01.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Adhesive small bowel obstruction (SBO) is a common postoperative complication. Published data in the pediatric literature characterizing SBO are scant. Furthermore, the relationship between the risk of SBO for a given procedure is not well described. To evaluate these parameters, we reviewed the incidence of SBO after laparoscopic appendectomy (LA) and open appendectomy (OA) performed at our institution. METHODS With institutional review board approval, all patients that developed SBO after appendectomy for appendicitis from January 1998 to June 2005 were investigated. Hospital records were reviewed to identify the details of their postappendectomy SBO. The incidences of SBO after LA and OA were compared with chi2 analysis using Yates correction. RESULTS During the study period, 1105 appendectomies were performed: 477 OAs (8 converted to OA during laparoscopy) and 628 LAs. After OA, 7 (6 perforated appendicitis) patients later developed SBO of which 6 required adhesiolysis. In contrast, a patient with perforated appendicitis developed SBO after LA requiring adhesiolysis (P = .01). The mean time from appendectomy to the development of intestinal obstruction for the entire group was 46 +/- 32 days. CONCLUSIONS The overall risk of SBO after appendectomy in children is low (0.7%) and is significantly related to perforated appendicitis. Small bowel obstruction after LA appears statistically less common than OA. Laparoscopic appendectomy remains our preferred approach for both perforated and nonperforated appendectomy.
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Affiliation(s)
- Kuo Jen Tsao
- Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA
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Slater B, Rangel S, Ramamoorthy C, Abrajano C, Albanese CT. Outcomes after laparoscopic surgery in neonates with hypoplastic heart left heart syndrome. J Pediatr Surg 2007; 42:1118-21. [PMID: 17560232 DOI: 10.1016/j.jpedsurg.2007.01.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND/PURPOSE Laparoscopy has advanced the care of children for a variety of pediatric surgical diseases. However, complication rates for laparoscopic interventions in neonates with hypoplastic left heart syndrome (HLHS) have not been well described. The purpose of this study is to present the largest reported series of laparoscopic surgery performed in patients with HLHS. METHODS We conducted a single-institution, retrospective chart review for all neonates with HLHS who underwent a laparoscopic procedure from September 2002 to March 2005. Data regarding patient characteristics, intraoperative monitoring, previous cardiac surgery, perioperative complications, and postoperative mortality were assessed. RESULTS Twelve patients with HLHS underwent a total of 13 operations during the study period (8 combined Nissen fundoplication and gastrostomy tubes, 3 isolated gastrostomy tubes, 1 Ladd procedure, and 1 combined Nissen fundoplication and gastrocutaneous fistula closure). All cases were completed laparoscopically. Patients had undergone palliative cardiac surgery but were not completely corrected; therefore, they were cyanotic. Perioperative complications were observed in 6 patients (3 gastrostomy tube site infections, 1 small bowel obstruction, 1 postoperative sepsis, and 1 urinary tract infection). There was no mortality in this series. CONCLUSIONS From this experience, it appears that laparoscopy can be performed safely and with satisfactory outcomes in patients with HLHS. However, a multidisciplinary approach, including the availability of a skilled and experienced cardiac anesthesia team, is believed to be critical to optimize outcomes in these critically ill children.
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Affiliation(s)
- Bethany Slater
- Department of Surgery, Division of Pediatric Surgery, Stanford University Medical Center, Lucile Packard Children's Hospital, Stanford, CA, USA
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Mallick MS, Al-Qahtani A, Al-Bassam A. Laparoscopic appendectomy is a favorable alternative for complicated appendicitis in children. Pediatr Surg Int 2007; 23:257-9. [PMID: 17115229 DOI: 10.1007/s00383-006-1833-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 10/16/2006] [Indexed: 10/23/2022]
Abstract
Laparoscopic appendectomy in children is a generally accepted procedure for the treatment of non-complicated acute appendicitis. Nevertheless, the role of laparoscopy in complicated appendicitis is more controversial. The objective of this study was to examine the safety, efficacy and complications of laparoscopy in children with complicated appendicitis. This is a retrospective review of the children who underwent laparoscopic appendectomy for complicated appendicitis at King Khalid University Hospital, Riyadh, Saudi Arabia between January 1998 and March 2006. Complicated appendicitis includes perforated appendicitis, gangrenous appendicitis and appendicular masses found intra-operatively. Data collected include demographic, duration of symptoms, operative time, analgesia, complications, length of hospitalization and histopathology. Laparoscopic appendectomy was done by three trocar technique in all cases. During the study period, 59 children aged 3-12 years underwent laparoscopic appendectomy for complicated appendicitis. There were 34 patients with perforated appendicitis, 12 patients with gangrenous appendicitis and 13 patients with appendicular mass. The average operating time was 62 min. The average length of hospitalization was 5 days. The post-operative narcotic analgesic requirement was minimal. Laparoscopy was converted to open surgery in two patients (3.38%). These two cases were excluded from further analysis. Four out of 57 patients (7.01%) had post-operative complications. Three patients (5.26%) developed wound infection. One patient (1.75%) developed haematoma at umbilical port site. There was no post-operative intra-abdominal collection. Laparoscopic appendectomy is a safe alternative for the treatment of complicated appendicitis. It does not increase the incidence of complications even with complicated appendicitis. Contrary to the previous studies, we did not have increased incidence of intra-abdominal collection in this review. However, prospective randomized controlled trials are needed to verify these findings.
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Affiliation(s)
- Mohammad Saquib Mallick
- Division of Pediatric Surgery, Department of Surgery (37), College of Medicine, King Khalid University Hospital, P. O. Box 7805, Riyadh, 11472, Saudi Arabia.
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Abstract
Appendicitis is the most common surgical disease of the abdomen in children. Pediatric appendicitis varies considerably in its clinical presentation, contributing to delay in diagnosis and increased morbidity. The methods of diagnosis and treatment of appendicitis also vary significantly among clinicians and medical centers according to the patient's clinical status, the medical center's capabilities, and the physician's experience and technical expertise. Recent trends include the increased use of radiologic imaging, minimally invasive and nonoperative treatments, shorter hospital stays, and home antibiotic therapy. Little consensus exists regarding many aspects of the care of the child with complicated appendicitis. This article examines the most debated aspects of the diagnosis and management of the diseased pediatric appendix.
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Affiliation(s)
- Stephen E Morrow
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
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43
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Partrick DA. Prospective evaluation of a primary laparoscopic approach for children presenting with simple or complicated appendicitis. Am J Surg 2006; 192:750-5. [PMID: 17161088 DOI: 10.1016/j.amjsurg.2006.08.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Revised: 08/10/2006] [Accepted: 08/10/2006] [Indexed: 11/16/2022]
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Yagmurlu A, Vernon A, Barnhart DC, Georgeson KE, Harmon CM. Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy. Surg Endosc 2006; 20:1051-4. [PMID: 16736313 DOI: 10.1007/s00464-005-0342-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Accepted: 02/23/2006] [Indexed: 01/07/2023]
Abstract
BACKGROUND The role of laparoscopic appendectomy for perforated appendicitis remains controversial. This study aimed to compare laparoscopic and open appendectomy outcomes for children with perforated appendicitis. METHODS Over a 36-month period, 111 children with perforated appendicitis were analyzed in a retrospective review. These children were treated with either laparoscopic (n = 59) or open appendectomy. The primary outcome measures were operative time, length of hospital stay, time to adequate oral intake, wound infection, intraabdominal abscess formation, and bowel obstruction. RESULTS The demographic data, presenting symptoms, preoperative laboratory values, and operative times (laparoscopic group, 61 +/- 3 min; open group, 57 +/- 3 were similar for the two groups (p = 0.3). The time to adequate oral intake was 104 +/- 7 h for the laparoscopic group and 127 +/- 12 h for the open group (p = 0.08). The hospitalization time was 189 +/- 14 h for the laparoscopic group, as compared with 210 +/- 15 h for the open group (p = 0.3). The wound infection rate was 6.8% for the laparoscopic group and 23% for the open group (p < 0.05). The wounds of another 29% of the patients were left open at the time of surgery. The postoperative intraabdominal abscess formation rate was 13.6% for the laparoscopic group and 15.4% for the open group. One patient in each group experienced bowel obstruction. CONCLUSIONS Laparoscopic appendectomy for the children with perforated appendicitis in this study was associated with a significant decrease in the rate of wound infection. Furthermore, on the average, the children who underwent laparoscopic appendectomy tolerated enteral feedings and were discharged from the hospital approximately 24 h earlier than those who had open appendectomy.
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Affiliation(s)
- A Yagmurlu
- Department of Pediatric Surgery, Ankara University School of Medicine, Dikimevi, Ankara, 06100, Turkey.
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Koontz CS, Smith LA, Burkholder HC, Higdon K, Aderhold R, Carr M. Video-assisted transumbilical appendectomy in children. J Pediatr Surg 2006; 41:710-2. [PMID: 16567181 DOI: 10.1016/j.jpedsurg.2005.12.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Video-assisted transumbilical appendectomy (VATA) is a combination of laparoscopic and open techniques and is not widely used in children. We are reporting our most recent experience with this technique. METHODS After the institutional review board approval, the charts of patients who underwent VATA between December 2003 and October 2004 were retrospectively reviewed. All children presenting with a preoperative diagnosis of appendicitis were candidates. A 10-mm trocar was placed in the umbilicus. An operating laparoscope was used for mobilizing the appendix. The appendix was delivered through the umbilicus. A standard extracorporeal appendectomy was performed. The umbilical ring was closed and the wound irrigated. Demographic and outcome data were collected and is presented as mean +/- SD. RESULTS Sixty-one males and 50 females underwent VATA (n = 111). Age and weight were 11 +/- 3.2 years and 49 +/- 22 kg, respectively. Six patients had previous abdominal surgery. Operative time was 36 +/- 24 minutes (range, 9-140 minutes). An additional trocar was placed in 2 patients, and 2 patients were converted to open. Five patients had additional procedures. Appendicitis was classified intraoperatively as acute (n = 44), suppurative (n = 5), gangrenous (n = 8), ruptured (n = 30), appendiceal colic (n = 13), and other (n = 11). Preoperative antibiotics were given to 95 patients and were continued in 35 patients postoperatively. Length of stay was 1.8 +/- 1.7 days (range, 1-11 days). Length of follow-up was 13 +/- 6.3 days (n = 90). Complications included intra-abdominal abscess (n = 1) and wound infection (n = 7). CONCLUSIONS Video-assisted transumbilical appendectomy minimizes equipment needs, thus, potentially reducing cost. Simple and complex appendectomies can be performed even if the patient has had previous abdominal surgery. Our complication rate was low, and our operating times and length of stay were short. Video-assisted transumbilical appendectomy is a safe and effective technique in children and can be used in lieu of the 3-trocar laparoscopic technique.
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Affiliation(s)
- Curt S Koontz
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga Unit, Chattanooga, TN 37403, USA
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Roumm AR, Pizzi L, Goldfarb NI, Cohn H. Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures. Surg Innov 2006; 12:261-87. [PMID: 16224649 DOI: 10.1177/155335060501200313] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is generally believed that minimally invasive surgery (MIS) results in less postoperative pain, fewer complications, and shorter recovery periods compared with open procedures. Yet despite these benefits, the level of reimbursement assigned to the surgeon by United States health-care payers is often lower than that for open procedures. Furthermore, the cost of performing a MIS may be higher vs an open procedure because specialized equipment, increased surgical time, or both may be required. In this report, we examine the issue by comparing reimbursements for MIS with open procedures, summarizing the medical literature on MIS vs open surgical procedures, and offering recommendations for payers who establish reimbursement policies. The review is focused on six MIS procedures where outcomes data exist: laparoscopic cholecystectomy (lap chole), laparoscopic colectomy (LC), laparoscopic fundoplication (LF), laparoscopic hysterectomy (LH), laparoscopic ventral hernia repair (LVHR), and laparoscopic appendectomy (LA). Outcomes summarized were length of hospital stay (LOS), operating room time, operating room costs, complications, and return to work or normal activities. The level of scientific evidence was assigned to each study using predetermined criteria. A total of 112 articles were reviewed: 14 for lap chole, 26 for LC, 7 for LF, 19 for LH, 9 for LVHR, and 37 for LA. The data demonstrate that these procedures result in reduced hospital stay, reduced hospital costs, and faster return to work or normal activities. Yet, the operating room time and costs are frequently higher for MIS. These findings suggest that as both the outcomes value and level of operating room resources are greater, MIS warrants reimbursement that meets or exceeds that of open procedures.
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Affiliation(s)
- Adam R Roumm
- Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA
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Aziz O, Athanasiou T, Tekkis PP, Purkayastha S, Haddow J, Malinovski V, Paraskeva P, Darzi A. Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg 2006; 243:17-27. [PMID: 16371732 PMCID: PMC1449958 DOI: 10.1097/01.sla.0000193602.74417.14] [Citation(s) in RCA: 246] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to use meta-analysis to compare laparoscopic and open appendectomy in a pediatric population. SUMMARY BACKGROUND DATA Meta-analysis is a statistical tool that can be used to evaluate the literature in both qualitative and quantitative ways, accounting for variations in characteristics that can influence overall estimate of outcomes of interest. Meta-analysis of laparoscopic versus open appendectomy in a pediatric population has not previously been performed. METHODS Comparative studies published between 1992 and 2004 of laparoscopic versus open appendectomy in children were included. Endpoints were postoperative pyrexia, ileus, wound infection, intra-abdominal abscess formation, operative time, and postoperative hospital stay. RESULTS Twenty-three studies including 6477 children (43% laparoscopic, 57% open) were included. Wound infection was significantly reduced with laparoscopic versus open appendectomy (1.5% versus 5%; odds ratio [OR] = 0.45, 95% confidence interval [CI], 0.27-0.75), as was ileus (1.3% versus 2.8%; OR = 0.5, 95% CI, 0.29-0.86). Intra-abdominal abscess formation was more common following laparoscopic surgery, although this was not statistically significant. Subgroup analysis of randomized trials did not reveal significant difference between the 2 techniques in any of the 4 complications. Operative time was not significantly longer in the laparoscopic group, and postoperative stay was significantly shorter (weighted mean difference, -0.48; 95% CI, -0.65 to -0.31). Sensitivity analysis identified lowest heterogeneity when only randomized studies were considered, followed by prospective, recent, and finally large studies. CONCLUSIONS The results of this meta-analysis suggest that laparoscopic appendectomy in children reduces complications. However, we also see the need for further high-quality randomized trials comparing the 2 techniques, matched not only for age and sex but also for obesity and severity of appendicitis.
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Affiliation(s)
- Omer Aziz
- Imperial College of Science, Technology and Medicine, Department of Surgical Oncology and Technology, St. Mary's Hospital, London, UK
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Li P, Xu Q, Ji Z, Gao Y, Zhang X, Duan Y, Guo Z, Zheng B, Guo X, Wu X. Comparison of surgical stress between laparoscopic and open appendectomy in children. J Pediatr Surg 2005; 40:1279-83. [PMID: 16080932 DOI: 10.1016/j.jpedsurg.2005.05.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The present study aimed to evaluate laparoscopic appendectomy (LA) in comparison with conventional open appendectomy (OA) in children, with special emphasis on the extent of surgical trauma after LA and OA, and to assess whether LA had any clear advantages compared with conventional OA. METHODS A total of 160 patients with a median age of 7.9 years (range 3-15 years) were studied. Sixty-nine of them underwent LA, and the remaining 91 underwent OA. Serum interleukin (IL) 6 and C-reactive protein (CRP) levels which are thought to play a pivotal role in the pathogenesis of surgical trauma and can also be used to monitor the magnitude of surgical trauma were measured using an enzyme-linked immunosorbent assay before surgery and 12 hours after surgery. In addition, we compared operating time, hospital stay, incidence of wound infection, and incidence of intra-abdominal infection. RESULTS The operative time of normal and suppurative appendix in the laparoscopic group was significantly shorter than that in the open group, respectively, but the operative time of gangrenous appendix was not different between the laparoscopic group and open group. The hospital stay in the laparoscopic group was also significantly shorter than that in the open group. Postoperatively, 1 patient had port-site infection in the laparoscopic group, whereas 10 had wound infection in the open group; this difference was highly significant (chi2 = 4.19, P < .05). Three patients in the open group and 2 patients in the laparoscopic group had intra-abdominal infection, and the difference had no statistically significant difference (chi2 = 0.10, P < .05). Preoperative IL-6 levels were not different between the 2 groups, but the rise (preoperative vs postoperative) of IL-6 in the laparoscopic group was remarkably less than that in the open group. Similar results were obtained for CRP; serum CRP levels in the basal state were not different between the 2 groups, but the rise (preoperative vs postoperative) of CRP in the laparoscopic group was also substantially less compared with that in the open group. CONCLUSIONS LA for children was as safe and effective as the open procedure and had significant advantages over OA because of less operating time, less postoperative complications, less surgical trauma, and more rapid postoperative recovery.
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Affiliation(s)
- Peng Li
- Department of Pediatric Surgery, the Second Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
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Goh BKP, Chui CH, Yap TL, Low Y, Lama TK, Alkouder G, Prasad S, Jacobsen AS. Is early laparoscopic appendectomy feasible in children with acute appendicitis presenting with an appendiceal mass? A prospective study. J Pediatr Surg 2005; 40:1134-7. [PMID: 16034758 DOI: 10.1016/j.jpedsurg.2005.03.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The management of an appendiceal mass remains controversial with 2 schools of thought; early surgical intervention vs nonoperative management with or without interval appendectomy. The aim is to determine the role and safety of early laparoscopic appendectomy (LA) in children with acute appendicitis presenting with an appendiceal mass. METHODS This is a prospective study of 88 consecutive pediatric patients who underwent attempted LA for suspected acute appendicitis at KK Women's and Children's Hospital, Singapore, between May and October 2003. RESULTS A total of 88 patients with a mean age of 10 +/- 3 years (range, 3-16 years) underwent LA for an appendiceal mass (n = 22), simple appendicitis (n = 36), other complicated (gangrenous or perforated) appendicitis (n = 23), and a normal appendix (n = 7). There were 7 conversions to open appendicectomy, 3 of which occurred in patients with an appendiceal mass. There were no perioperative or postoperative mortalities. Morbidity occurred in only one patient who underwent LA for perforated appendicitis. He had prolonged sepsis that resolved after 2 weeks of intravenous antibiotics. None of the patients with an appendiceal mass developed complications. Patients who underwent early LA for an appendiceal mass had a statistically significant (P < .05) longer operating time (median, 103 minutes; interquartile range, 90-151 minutes, vs median, 87 minutes; interquartile range, 71-112 minutes), prolonged time to ambulation (median, 2.0 days; interquartile range, 2-2.5 days, vs median, 1.0 days; interquartile, 1-2 days), increased time to resumption of diet (median, 4 days; interquartile, 3-5 days, vs median, 2 days; interquartile, 2-3 days), and longer postoperative stay (median, 6.0 days; interquartile, 5.5-6.5 days, vs median, 4.0 days; interquartile, 3-5.5 days) compared with patients presenting with appendicitis without mass formation. However, there was no statistical difference in these parameters when LA for an appendiceal mass was compared with LA for other complicated appendicitis (perforated and gangrenous). CONCLUSION Although early LA for an appendiceal mass is a technically demanding procedure, it can be performed safely in children with minimal morbidity and mortality. In an era where patients' demand for "key-hole" surgery is rising, early LA is a safe and viable option in the management of children with an appendiceal mass. It also offers the advantage of avoiding misdiagnoses and the need for a second hospitalization.
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Affiliation(s)
- Brian K P Goh
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 229899, Singapore.
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Phillips S, Walton JM, Chin I, Farrokhyar F, Fitzgerald P, Cameron B. Ten-year experience with pediatric laparoscopic appendectomy--are we getting better? J Pediatr Surg 2005; 40:842-5. [PMID: 15937827 DOI: 10.1016/j.jpedsurg.2005.01.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to compare our initial (1994-1997) and recent (2001-2003) experiences in laparoscopic appendectomy (LA). METHODS A 2-year (2001-2003) retrospective chart review of cases of appendicitis was performed and compared with data obtained from 1994 to 1997 cases. Operating and anesthetic times as well as postoperative outcomes were analyzed. Cases of conversion to open appendectomy were included in the analysis. RESULTS Two hundred and thirty-three LA cases from 2001 to 2003 were compared with 119 cases from 1994 to 1997. Operating time decreased significantly from 58 to 47 minutes in acute appendicitis (AA) and from 80 to 58 minutes in perforated appendicitis (PA). Anesthetic time decreased significantly in both AA (82 to 71 minutes) and PA (106 to 84 minutes). There were significant decreases in the conversion rate in PA (23.4% to 3.5%), although no change was seen in AA. In PA, the incidence of postoperative abscess decreased from 36.2% to 16.5%. There was no significant decrease in length of stay, amount of analgesia used, time to resume regular diet, or incidence of wound infections and bowel obstructions. CONCLUSIONS Ten years of experience in LA has resulted in decreases in anesthetic and operating times for AA and PA as well as decreases in the incidence of abscesses and conversion rates.
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Affiliation(s)
- Stephanie Phillips
- Division of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada L8N 3Z5
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