Laparoscopic appendicectomy in children: A trainee's perspective.
BACKGROUND
The emergence of operative laparoscopy has brought a great demand for training surgical residents, but there are no clear guidelines regarding choice of procedure for training, proficiency assessment and accreditation. We aim to examine from a trainee's point of view, the safety and efficacy of laparoscopic appendicectomy (LA) as a laparoscopic training procedure.


METHODS
A retrospective analysis of all the consecutive cases of LA done by a trainee in paediatric laparoscopic surgery from September 2003 to February 2005 was done.


RESULTS
A total of 70 consecutive patients (37 males and 33 females) aged 3 to 15 years (mean, 10.5 +/- 2.5) with suspected appendicitis underwent LA. Twelve (17.1%) patients had acute appendicitis, 25 (35.7%) had acute suppurative appendicitis adherent to the caecum with localised and/or pelvic pus pocketing, 29 (41.4%) had perforated appendicitis with generalised peritonitis and 4 (5.7%) had normal appendix [mesenteric adenitis (1), omental infarct (1), torted Meckel's diverticulum (1) and primary peritonitis (1)]. There were no operative complications and none required conversion to open surgery. The operative duration ranged from 25 to 110 minutes (mean, 55.6 +/- 23.4). There were two complications; one had adhesive intestinal obstruction and underwent successful laparoscopic adhesiolysis and one had umbilical wound infection.


CONCLUSIONS
LA is a safe and effective laparoscopic training procedure, in addition to being effective for all stages of appendicitis, as well as concurrent lesions encountered in children with suspected appendicitis.
Sai Prasad
T R
TR
Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore. trsai@rediffmail.com
Chui
Chan Hon
CH
Jacobsen
Anette Sundfor
AS
D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy / Q000193:education* / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004503:Education, Medical, Graduate; D005260:Female; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D012449:Safety; D012846:Singapore