Perforated appendicitis in children: benefits of early laparoscopic surgery.
BACKGROUND
The aim of this study was to analyse the feasibility, safety and benefits of laparoscopic appendicectomy (LA) in comparison with open appendicectomy (OA) for perforated appendicitis (PA) in children.


METHODS
A retrospective analysis of all consecutive cases of PA who underwent OA or LA between July 2001 and April 2004 was done. The patient demographics, duration of symptoms and operative findings were noted and the feasibility, safety and benefits of LA were analysed with respect to postoperative recovery and complications.


RESULTS
One hundred and thirty-seven consecutive patients with PA underwent either OA (n = 46) or LA (n = 91). Both groups were comparable with respect to patient demographics, duration of symptoms and operative findings. The mean operative time was 106.5 min (95% CI, 100.2 - 112.8) in the LA group and 92.8 min (95% CI, 82.9-102.7) in the OA group (P = 0.02). The return to afebrile status after surgery was significantly faster in the LA group [mean, 45.4 hours (95% CI, 36.8-54)] than the OA group [mean, 77 hours (95% CI 56.7-97.3)] (P = 0.007). The mean duration for postoperative opioid analgesia was 2.5 days (95% CI, 2.2-2.7) for LA and 3.2 days (95% CI, 2.9- 3.6) for OA (P = 0.001). The resumption of oral feeds after surgery was at 3.1 days (95% CI, 2.8-3.3) for LA and 3.7 days (3.4-4.1) for OA (P = 0.005). The length of the hospital stay was shorter in the LA group [mean, 6.5 days (95% CI, 6.1-6.8)] as compared to that of the OA group [mean, 8.2 days (95% CI, 7.1-9.3)] (P = 0.006). Postoperative complications included wound infection, adhesive intestinal obstruction and pelvic abscess formation. The incidence of these complications was 5.6% in the LA group and 19.6% in the OA group (P = 0.01). Nine patients (9.8%) needed conversion to open surgery in the LA group. None of the LA patients had wound infection.


CONCLUSIONS
LA is feasible, safe and beneficial in children with PA.
Rai
Rambha
R
Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
Chui
Chan-Hon
CH
Sai Prasad
T R
TR
Low
Yee
Y
Yap
Te-Lu
TL
Jacobsen
Anette Sundfor
AS
D000367:Age Factors; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D012189:Retrospective Studies; D012449:Safety; D013997:Time Factors; D016896:Treatment Outcome