Perforating appendicitis. An indication for laparoscopy?
BACKGROUND
This pilot study was performed to reassess the widespread postulate that laparoscopic surgery is contraindicated in cases of perforating appendicitis.


METHODS
A total of 75 children (appendiceal perforation: n = 67; perityphlic abscesses and peritonitis: n = 8) were analyzed in a prospective nonrandomized trial. Ten of them were treated by laparoscopic appendectomy.


RESULTS
In the laparoscopy group, both pain and hospitalization were less time-consuming (i.e., by 50% and 19%, respectively). Antibiotics use was down from 2.6 over 6 days to 2.2. over 5.5 days, while the duration of surgery was up by 52%. Wound healing disturbances occurred in 10% (n = 1) and postoperative fever in 50% (n = 5) of patients, compared to 14% (n = 9) and 15% (n = 10) in the group treated by open surgery. All severe complications requiring reintervention (10%; massive subcutaneous abscess, n = 3; retrocolic abscess, n = 2; adhesion-related ileus, n = 3; appendicular stump, n = 1) were associated with open surgery.


CONCLUSIONS
There was not a single major complication in the laparoscopy group. These unexpected results are in contrast to previous reports and have prompted us to initiate a prospective randomized trial.
Paya
K
K
Department of Pediatric Surgery, University of Vienna, Medical School, Waehringerguertel 18-20, A-1090 Vienna, Austria.
Rauhofer
U
U
Rebhandl
W
W
Deluggi
S
S
Horcher
E
E
D001064:Appendicitis / Q000601:surgery*; D002648:Child; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D010535:Laparoscopy; D010865:Pilot Projects; D011446:Prospective Studies