Laparoscopic appendicectomy for complicated appendicitis in children

Introduction: The place of laparoscopic appendicectomy in the management of complicated appendicitis remains unsettled with reports of a higher incidence of postoperative intraperitoneal abscess. Most studies on laparoscopic appendicectomy in children have been done in the Western population. This retrospective review was done to compare laparoscopic appendicectomy with open appendicectomy in children with complicated appendicitis in a hospital in Malaysia. Methods: The laparoscopic appendicectomies were done by a single surgeon, while the open appendicectomies were performed by surgical trainees with at least three years of surgical experience. There was no selection of cases for laparoscopic appendicectomy. Both procedures were done by standard techniques. The operative time, duration of postoperative stay, wound infection rate, incidence of intraperitoneal abscess and postoperative fever were compared. Results: Based on the intention to treat analysis, there were 51 and 61 children in the laparoscopic and open appendicectomy groups, respectively. Conversion from laparoscopy to open technique was done in six children. Distribution of age, gender and pathology of appendicitis was similar for the two groups. With laparoscopic appendicectomy, the mean operative time was longer (112 vs. 72 minutes, p-value is less than 0.005), while severe wound infection (2.1 vs. 21 percent, p-value is less than 0.05) and mean postoperative hospital stay (5.7 vs. 7.4 days, p-value is less than 0.005) were significantly lower. The incidence of postoperative intraperitoneal abscess (12 vs. 11.5 percent) and postoperative fever (20 vs. 11.5 percent) were not significantly different (p-value is greater than 0.05). Conclusion: This review has confirmed that the longer the operating time, the lower the incidence of wound infection and the shorter the postoperative stay for laparascopic appendicectomy. There was no increased risk of postoperative intraperitoneal abscess.