Laparoscopic appendectomy is associated with lower morbidity in extremely obese children.
OBJECTIVE
In recent years there has been worldwide increase in childhood obesity. However, in the beginning laparoscopic appendectomy in obese children was contraindicated, now it is commonly used for the treatment of appendicitis. The purpose of this study was to compare open versus laparoscopic appendectomy in extremely obese children.


METHODS
The hospital records of 1,383 consecutive patients, who underwent appendectomy for acute appendicitis between 2000 and 2009 were analyzed. 238 children (17.2%) were extremely obese. Extremely obese was defined, as greater than 2 standard deviations above the standardized mean weight for age. 61 of 238 (25.6%) patients had open appendectomy and 177 (74.3%) underwent laparoscopic appendectomy. The length of hospital stay, operation time, complication rate and frequency of taking postoperative pain relief were compared between open and laparoscopic appendectomy in extremely obese children.


RESULTS
The incidence of complicated and non-complicated appendicitis was similar both in open and laparoscopic appendectomy group. Laparoscopic appendectomy for acute appendicitis in extremely obese children is associated with significantly shorter operating time (46.8 vs. 59.87 min, P < 0.05), lower overall complication rate (5 vs. 8.2%, P < 0.05) and lesser postoperative analgesia requirement (6.97× vs. 4.73×, P < 0.05).


CONCLUSIONS
Laparoscopic appendectomy should be the procedure of choice for the treatment of acute appendicitis in extremely obese children.
The National Children's Hospital, Dublin, Dublin 24, Ireland.
Balazs
B
Kutasy
Manuela
M
Hunziker
Ganapathy
G
Laxamanadass
Prem
P
Puri
D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000453:epidemiology*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D010147:Pain Measurement
Eur J Clin Nutr. 2007 Jun;61(6):743-51
17180155
Am J Surg. 2007 Dec;194(6):877-80; discussion 880-1
18005788
Eur J Pediatr. 2006 Oct;165(10):696-700
16691404
Lancet. 2002 Aug 10;360(9331):473-82
12241736
Am J Surg. 2008 Aug;196(2):218-22
18519131
J Pediatr Surg. 2007 May;42(5):857-61
17502199
Br J Surg. 2001 Apr;88(4):510-4
11298617
Ann Intern Med. 1986 Apr;104(4):540-6
3513685
J Pediatr Endocrinol Metab. 2003 Feb;16(2):211-6
12713259
Minerva Pediatr. 2003 Oct;55(5):453-9
14608268
Surg Laparosc Endosc. 1996 Jun;6(3):205-9
8743364
Surg Endosc. 2001 Apr;15(4):387-92
11395821
Lancet. 2003 Jun 14;361(9374):2032-5
12814714
Surg Endosc. 1997 Apr;11(4):336-40
9094272
Ann Surg. 2006 Jan;243(1):17-27
16371732