title: Open versus laparoscopic appendectomy in the pediatric population: a literature review and analysis of complications.
abstract: BACKGROUND
  This study aims to compare the results of laparoscopic and open appendectomy (LA and OA, respectively) in a pediatric population with particular attention to complications analysis.
  
  
  METHODS
  A literature search was performed using Medline, Cochrane, Embase, Sci Search, Lilacs, and PubMed databases on all studies published during the 14-year interval of 1997-2010. Comparative studies of LA versus OA in the pediatric population were included in these studies. Data concerning operative time, length of hospital stay, postoperative complications, postoperative pain, and surgical trauma were recorded.
  
  
  RESULTS
  We recorded 52 studies, but 26 of these were excluded from our analysis because they were neither relevant nor related to the adolescent population. The 26 studies analyzed showed a population of 123,628 children and adolescents (ages 0-18 years) who underwent appendectomy by laparoscopic (LA, 42,213 [34.1%]) and open (OA, 81,415 [65.9%]) techniques. Our analysis showed that patients undergoing LA presented a lower incidence of surgical wound infection, lower incidence of postoperative ileus, a lower use of analgesics in the postoperative period, an earlier resumption of normal diet, a shorter hospitalization, and a more rapid recovery to resume normal activities compared with patients undergoing OA. This study, comparing LA versus OA in children, failed to identify any major difference between the two techniques in terms of formation of intra-abdominal abscesses. As for operative time, our analysis showed globally a significant reduced operative time in OA versus LA in complicated appendicitis, but in simple appendicitis the operative time seems to be the same.
  
  
  CONCLUSIONS
  Our analysis of the literature showed that the LA technique presents several advantages compared with the OA technique. For this reason, if a child is hospitalized today for appendicitis treatment in a pediatric center where the laparoscopic approach is unavailable, he or she should be placed on antibiotics and transferred to a center that offers the laparoscopic approach.
authors.affiliation: Department of Pediatrics, Federico II University of Naples, Via Pansini 5, Naples, Italy. ciroespo@unina.it
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.forename: Andres Ignacio
authors.initials: AI
authors.lastname: Calvo
authors.forename: Marco
authors.initials: M
authors.lastname: Castagnetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Alicchio
authors.forename: Carlos
authors.initials: C
authors.lastname: Suarez
authors.forename: Ida
authors.initials: I
authors.lastname: Giurin
authors.forename: Alessandro
authors.initials: A
authors.lastname: Settimi
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D006801:Humans; D045823:Ileus / Q000453:epidemiology*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology*