title: Early laparoscopic management of appendicular mass in children: Still a taboo, or time for a change in surgical philosophy?
abstract: BACKGROUND
  Early appendicectomy has been found to be a safe and better alternative for management of appendicular mass in various studies in adults, while very few studies report such advantages in the paediatric population. We conducted this study to assess the safety, efficacy and need of early laparoscopic appendicectomy (ELA) in child patients with appendicular mass.
  
  
  METHODS
  All patients with appendicular mass who underwent ELA at our institute between September 2011 and August 2014 were retrospectively reviewed. Appendicular mass was defined as a right iliac fossa mass in a case of acute appendicitis, diagnosed by clinical, laboratory and radiological evaluation, and palpation under anaesthesia, the patient being subjected to laparoscopic treatment.
  
  
  RESULTS
  Forty-eight (48) patients were confirmed to have appendicular mass intraoperatively and were included in the analysis. There were 30 males and 18 females, with ages ranging 7-13 years (mean 9 years). In the present study, appendicular complications included appendicular abscess (62.5%), gangrenous appendicitis (25%), sloughed-out appendix (8.33%) and appendicular perforation (4.16%). The average operative time was 72 min (range 45-93 min). One case (1.92%) required conversion to open procedure due to failure of identification of the appendicular base of a sloughed-out appendix. Post-operative complications were found in 4 (7.69%) patients, of whom 3 (5.76%) had minor wound infection at the umbilical port site and 1 (1.92%) had post-operative pelvic abscess, which was managed with percutaneous aspiration.
  
  
  CONCLUSIONS
  ELA avoids misdiagnosis, treats complicated appendicitis at its outset, and avoids complications and/or failure of non-operative treatment of a potentially lethal, diseased appendix. This approach is associated with minimal complications in experienced hands and is a safe and feasible option in children with appendicular mass.
authors.affiliation: Department of Pediatric Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Vikesh
authors.initials: V
authors.lastname: Agrawal
authors.affiliation: Department of Pediatric Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Acharya
authors.affiliation: Department of Pediatric Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Roshan
authors.initials: R
authors.lastname: Chanchlani
authors.affiliation: Department of Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Dhananjaya
authors.initials: D
authors.lastname: Sharma
keywords: Appendicular mass; children; laparoscopy