title: Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases.
abstract: OBJECTIVE
  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.
authors.affiliation: Pediatric Surgery Unit, Magna Graecia University Catanzaro and Federico II University of Naples, Piazza degli Artisti 7/c, 80129 Naples, Italy. ciroesp2@unicz.it
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.forename: Peter
authors.initials: P
authors.lastname: Borzi
authors.forename: Jean Stephane
authors.initials: JS
authors.lastname: Valla
authors.forename: Monghi
authors.initials: M
authors.lastname: Mekki
authors.forename: Abdelatif
authors.initials: A
authors.lastname: Nouri
authors.forename: Francois
authors.initials: F
authors.lastname: Becmeur
authors.forename: Hossein
authors.initials: H
authors.lastname: Allal
authors.forename: Alessandro
authors.initials: A
authors.lastname: Settimi
authors.forename: Felix
authors.initials: F
authors.lastname: Shier
authors.forename: MiguelAntonio Gonzales
authors.initials: MG
authors.lastname: Sabin
authors.forename: Luciano
authors.initials: L
authors.lastname: Mastroianni
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome