Page 28 - World Journal of Laparoscopic Surgery

Analyzing the Outcomes of Laparoscopic Appendectomies in Children

Fig. 1: Demographics (gender) Fig. 3: Average length of stay
complications and unrelated events. Out of the 12 patients,
complications were encountered in 11 patients and 1 patient
developed an unassociated event during the hospital stay. The
complications were graded as per the Clavein–Dindo criteria and
further divided into two groups, namely, minor (grades I and II)
and major (grade ≥III).
• Complications
– Minor (grades I and II): 6
– Major (grade ≥III): 5
• Unrelated event
– Testicular torsion: 1
An interesting point to be noted here is that out of the 11 patients
who encountered complications, only 6 patients presented with
and were operated on for complicated appendicitis while the other
5 patients had uncomplicated appendicitis, giving us more than
50% chance of patients with postoperative complications having
Fig. 2: Demographics (age) a history of complicated appendicitis.
pie chart suggests that males tend to have a higher incidence dIscussIon
of appendicitis in the pediatric age-group compared to females, Appendicitis is the most common acute abdominal emergency. The
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approximately in the ratio of 2:1 (males:females). mention of this condition can be dated back to as early as 30 AD,
2
Demographics (Age) where its presence was recorded by Aretaeus the Cappadocean.
Figure 2 depicts the demographic distribution of the age of However, the first description of the appendix was given by the
patients who presented with appendicitis at our institution. The anatomist Berengario de Carpi in 1521, and the first appendectomy
graph suggests that patients presenting with appendicitis are most was performed over 200 years later by Claudius Amyand in
2
commonly in the age-group of 6–10 years old followed by 11–15-year 1735. The term “appendicitis” was coined by the pathologist−
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old which was the second most common. physician Reginald Fitz in 1886; however, it was Robert Tait who
first diagnosed an appendicitis and then surgically removed the
Average Length of Stay appendix in 1880, and in 1889, he also became the first one to split
Figure 3 depicts the distribution of the ALOS of the patients open and drain an appendix without removing it. 3
[measured (in hours) from the time of admission to the time of The well-renowned Mcburney’s point as well as Mcburney’s
discharge] irrespective of the type of appendicitis operated i.e., incision were first described and named after Charles Mcburney,
complicated or uncomplicated. The pie chart suggests that most who proposed a muscle splitting incision in 1893, which was later
patients were discharged from the hospital within 48–96 hours of modified by Robert Weir in 1900. 3
admission for the surgery irrespective of the type of appendicitis The shortcoming of Mcburney’s, also known as Gridiron
operated, i.e., complicated or uncomplicated. incision, that is, a non-cosmetic scar was overcome by Elliot of
Boston and Otto Lanz. Lanz described an incision one-third of the
Adverse Events way along the interspinal line, which paved way for a cosmetically
In our study cohort, we encountered adverse events in 12 patients. acceptable scar which formed the principle behind a laparoscopic
The adverse events were divided into two groups, namely, appendectomy. 4

124 World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)