Laparoscopic appendectomy in children

OBJECTIVE: Laparoscopic appendectomy (LA) is rapidly becoming an alternative to open appendectomy for the treatment of appendicitis in children. We examined the efficacy, safety and complications of performing LA in children.

METHODS: This is a critical review of the children who underwent LA between January 1999 and May 2003 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Demographic data, operative procedures, severity of appendicitis, histopathology, operative time, hospital stay, analgesia and complications were carefully analyzed.

RESULTS: Laparoscopic appendectomy was attempted in 113 children. It was successfully completed in only 100 patients, 85 had uncomplicated appendicitis and 15 had complicated appendicitis. In 13 (11.5%) conversion to open appendectomy had to be carried out for complicated appendicitis. Their ages ranged between 2-12 years (average 8 years); 52 were males and 48 were females. Symptom duration average was 30 hours in uncomplicated appendicitis and 56 hours in complicated appendicitis. Operative time ranged between 35-80 minutes (average 53 minutes). Four patients with complicated appendicitis developed postoperative complications, 2 had wound infections and the other 2 had intra-abdominal collections. No intra-operative complications were encountered. The average hospital stay was 2 days for uncomplicated appendicitis and 6 days for complicated ones. Histopathological examination revealed 75 acutely inflamed appendices, 15 were perforated appendicitis with or without mass formation and 10 appendices reported to be normal. All patients were followed up for 6-12 months.

CONCLUSION: Laparoscopic appendectomy is both a safe and effective method in managing children with acute uncomplicated appendicitis. In children with complicated appendicitis, LA should be carried out with caution and only by an experienced surgeon, as it is associated with a higher rate of conversion to open technique and more postoperative infectious complications.