title: Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach.
abstract: BACKGROUND
  Adhesive small bowel obstruction (SBO) is a common postoperative complication. Published data in the pediatric literature characterizing SBO are scant. Furthermore, the relationship between the risk of SBO for a given procedure is not well described. To evaluate these parameters, we reviewed the incidence of SBO after laparoscopic appendectomy (LA) and open appendectomy (OA) performed at our institution.
  
  
  METHODS
  With institutional review board approval, all patients that developed SBO after appendectomy for appendicitis from January 1998 to June 2005 were investigated. Hospital records were reviewed to identify the details of their postappendectomy SBO. The incidences of SBO after LA and OA were compared with chi2 analysis using Yates correction.
  
  
  RESULTS
  During the study period, 1105 appendectomies were performed: 477 OAs (8 converted to OA during laparoscopy) and 628 LAs. After OA, 7 (6 perforated appendicitis) patients later developed SBO of which 6 required adhesiolysis. In contrast, a patient with perforated appendicitis developed SBO after LA requiring adhesiolysis (P = .01). The mean time from appendectomy to the development of intestinal obstruction for the entire group was 46 +/- 32 days.
  
  
  CONCLUSIONS
  The overall risk of SBO after appendectomy in children is low (0.7%) and is significantly related to perforated appendicitis. Small bowel obstruction after LA appears statistically less common than OA. Laparoscopic appendectomy remains our preferred approach for both perforated and nonperforated appendectomy.
authors.affiliation: Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
authors.forename: Kuo Jen
authors.initials: KJ
authors.lastname: Tsao
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Valusek
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Keckler
authors.forename: Susan
authors.initials: S
authors.lastname: Sharp
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology*; D045822:Intestinal Volvulus / Q000453:epidemiology / Q000209:etiology; D007421:Intestine, Small / Q000601:surgery*; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology*