title: Laparoscopic appendectomy in children after the learning curve.
abstract: OBJECTIVE
  Despite its increasing popularity, several recent studies comparing laparoscopic appendectomy (LA) with open appendectomy (OA) in children have failed to demonstrate significant improvements in patient outcomes. Many series include the "learning curve," wherein surgeons inexperienced with laparoscopic techniques compare their results with results with OA with its extensive history. This study was designed to investigate outcomes in pediatric appendectomy patients managed by surgeons with extensive laparoscopic experience.
  
  
  METHODS
  We preformed a retrospective review of 197 consecutive children undergoing appendectomy for presumed acute appendicitis from January 2002 through May 2004 at a university-affiliated community hospital by pediatric and general surgeons with extensive laparoscopic surgical experience.
  
  
  RESULTS
  The study included 117 patients who underwent LA and 80 who underwent OA. Of 122 acute appendicitis cases, mean operating times were 47 minutes (LA) and 48 minutes (OA). The LA group (n=71) had a faster return to full diet (17.6 h vs. 28.6 h, P=0.0008), and shorter postoperative length of stay (LOS) (1.06 d vs. 1.66 d, P<0.0001) compared with the OA group (n = 51). Complication rates, time on intravenous (IV) antibiotics, and IV opiates were similar among the 2 groups. Complicated appendicitis cases (LA, n=34; OA, n=26) were similar with regard to LOS, return to normal bowel function, complication rate and time on IV antibiotics and opiates, but was associated with an increased operation time (LA, 65 min; OA, 51 min, P=0.02).
  
  
  CONCLUSIONS
  Following the completion of the laparoscopic surgery learning curve, LA has a comparable operation time and results in a decreased postoperative LOS, and faster return to normal bowel function compared with OA in children with acute nongangrenous, nonperforated appendicitis.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: York
authors.forename: Angela
authors.initials: A
authors.lastname: Smith
authors.forename: Daniel
authors.initials: D
authors.lastname: von Allmen
authors.forename: J Duncan
authors.initials: JD
authors.lastname: Phillips
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000592:standards; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome