Page 3 - World Journal of Laparoscopic Surgeons

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WJOL S

10.5005/jp-journals-10007-1324
Laparoscopic Appendectomy for Perforated Appendicitis in Children
ORIGINAL RESEARCH

Laparoscopic Appendectomy for Perforated Appendicitis

in Children

2
1 Hesham Kasem, Wael Alshahat

ABSTRACT rate is usually due to delayed diagnosis, as the child
Aim: To evaluate the outcome of laparoscopic (LA) vs open is usually less communicative and the symptoms are
appendectomy (OA) in children with perforated appendicitis. usually diagnosed as gastroenteritis. 3
Laparoscopic appendectomy has become the pre-
Materials and methods: Retrospective review was conducted
from January 2013 to October 2016 evaluating 81 patients ferred method in treatment of simple noncomplicated
with perforated appendicitis based on surgical approach. We appendicitis, but there is still a controversy about the
compared demographics, mean operative time, length of stay, use of laparoscope in complicated appendicitis with
infectious complications, and follow-up in patients with OA concern about intraabdominal abscess and long opera-
(n = 37) and LA (n = 44).
tive time. 4,5
Results: Compared with OA, LA resulted in a lower rate of
wound infection (4.5 vs 8.1.5%; p < 0.05). The occurrence of
the intraabdominal abscess was significantly lower in the LA MATERIALS AND METHODS
group (0 vs 5.4%; p < 0.05). There was a significant difference
in the duration of operation between the two groups; it was This is a retrospective study which has been done in
61.6 ± 20.3 minutes in OA, compared with the LA group (51.6 Zagazig University Hospital and International Medical
± 28.6 minutes) (p < 0.05). Center, Jeddah, from the period from January 2013 to
Conclusion: We conclude that LA provides better postopera- October 2016.
tive course, less postoperative pain, and less postoperative All cases operated for perforated appendicitis were
complications. included in the study.
Keywords: Children, Complicated appendicitis, Complications, During this period, all children less than 14 years who
Laparoscopic appendectomy, Open appendectomy. underwent appendectomy for perforated appendicitis
How to cite this article: Kasem H, Alshahat W. Laparoscopic has been evaluated regarding type of operation (OA or
Appendectomy for Perforated Appendicitis in Children. World LA), demographic data (age, sex), operative time, dura-
J Lap Surg 2018;11(1):1-4. tion of hospital stay, complication rate which includes
Source of support: Nil wound infection, abdominal infection, adhesive intestinal

Conflict of interest: None obstruction, and readmission.
We use the Student’s t-test to evaluate the statistical
significance with a p-value of 0.05 or less considered as
INTRODUCTION
statistically significant.
Acute appendicitis is one of the most common causes
of surgical abdomen in children and accounts for 1/3 of Surgical Technique
1
childhood admission for abdominal pain. Perforation
is most common in young children with rate as high as Laparoscopic appendectomy was performed through
82% in age under 5 years and up to 100% in 1-year-old three ports. After general anesthesia, an 11-mm port
children. The overall incidence of perforation varies from was inserted through the umbilicus by open technique.
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20 to 76% with a median of 36%. The high perforation Pneumoperitoneum was created to a pressure of 10 to
12 mm Hg by carbon dioxide insufflation. Another two
5-mm ports were inserted, one in the left iliac fossa and
the other one in the suprapubic region. The appendix was
1,2 Pediatric Surgeon
visualized by release of all adhesions around it, mesoap-
1,2 Department of Pediatric Surgery, Zagazig University, Zagazig pendix was controlled by harmonic scalpel or any other
Egypt; International Medical Center, Jeddah, Kingdom of Saudi
Arabia energy device as ligature or diathermy, the base of the
appendix was ligated by Vicryl endoloop, and, in one
Corresponding Author: Hesham Kasem, Pediatric Surgeon
Department of Pediatric Surgery, Zagazig University, Zagazig case, was divided by endo GIA stapler. The appendix
Egypt; International Medical Center, Jeddah, Kingdom of Saudi was removed in endobag from the umbilical port, the
Arabia, Phone: +00201100035674, e-mail: kassemhesham91@ small intestine was explored by a traumatic grasper to
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release any interloper adhesion or pus. Good peritoneal
World Journal of Laparoscopic Surgery, January-April 2018;11(1):1-4 1