Is there a role for laparoscopic appendectomy in pediatric surgery?
Although laparoscopic procedures are currently in vogue in general surgery, the role of this approach in children has not been prospectively evaluated in the United States using the new instrumentation now available to us. To assess the value of laparoscopic appendectomy (LA) in childhood, we prospectively compared 14 LAs with 50 open appendectomies (OA) over 6 months in a single children's hospital. Antibiotic usage was at the discretion of the surgeon regardless of the procedure performed and was not different between groups. LA was performed under the direction of a single laparoscopy-trained surgeon and patient selection was based on parental consent. A three-puncture LA technique was used; children from this group were allowed to return to full activities as soon as they were comfortable. There were no significant differences between groups for severity of disease, age, weight, hospital cost, or complications. The types of complications that developed were comparable in both groups. The percent of complicated appendicitis (gangrene or perforation) was 32% in the OA group and 36% in the LA group. Patients in the LA group spent significantly fewer days in the hospital and returned to unrestricted activities (school, athletics, etc) faster than patients in the OA group. LA is approximately $1,000 more expensive than OA, the differences being easily explainable by the cost of the disposable supplies necessary for the procedure (laser fibers, trocars, etc), but because of the shorter hospital stay in the LA group the mean total cost for each group was comparable. These data suggest that although there appears to be no cost advantage, LA shortens the hospital stay and allows children to return to unrestricted activity sooner than OA.(ABSTRACT TRUNCATED AT 250 WORDS)
Gilchrist
B F
BF
Department of Surgery, The University of Tennessee, Memphis.
Lobe
T E
TE
Schropp
K P
KP
Kay
G A
GA
Hixson
S D
SD
Wrenn
E L
EL
Philippe
P G
PG
Hollabaugh
R S
RS
D000038:Abscess / Q000601:surgery; D001062:Appendectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D003365:Costs and Cost Analysis; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D007902:Length of Stay; D011446:Prospective Studies; D012422:Rupture, Spontaneous / Q000601:surgery; D013997:Time Factors; D000267:Tissue Adhesions / Q000601:surgery