Page 5 - World Journal of Laparoscopic Surgeons

WJOLS

Laparoscopic Appendectomy for Perforated Appendicitis in Children
retrospective study was 1.2%. In our study, we used a REFERENCES
harmonic scalpel to control and divide the meso appen- 1. Lintula H, Kokki H, Vanamo K. Single-blind randomized
10
dix with good control and no intraoperative bleeding. clinical trial of laparoscopic versus open appendicectomy
Wound infection is a common complication after appen- in children. Br J Surg 2001 Apr;88(4):510-514.
dectomy, and most of the studies report wound infection 2. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic
rate to be less than 0.2% in nonperforated appendix and versus open surgery for suspected appendicitis. Cochrane
5.7% in perforated appendix. 11,12 In the present study, Database Syst Rev 2010 Oct;10:CD001546.
the wound infection was more common in OA group 3. Little DC, Custer MD, May BH, Blalock SE, Cooney DR.
Laparoscopic appendectomy: an unnecessary and expensive
than in the LA group (4.5 vs 8.1%; p < 0.05). And this procedure in children? J Pediatr Surg 2002 Mar;37(3):310-317.
is the case with most published studies. 13-15 This lower 4. Meguerditchian AN, Prasil P, Cloutier R, Leclerc S, Péloquin J,
infection rate may be related to avoiding direct contact Roy G. Laparoscopic appendectomy in children: a favorable
of the inflamed appendix and the infected fluid with the alternative in simple and complicated appendicitis. J Pediatr
abdominal wall, as the appendix was removed through Surg 2002 May;37(5):695-698.
endobag and the infected abdominal fluid is aspirated 5. Lintula H, Kokki H, Vanamo K, Antila P, Eskelinen M. Lapa-
roscopy in children with complicated appendicitis. J Pediatr
under vision, but in OA, the wound usually is contami- Surg 2002 Sep;37(9):1317-1320.
nated from the infected fluid or the inflamed appendix. 6. Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, Liu Y. Laparo-
16
Jen et al reported the incidence of postoperative abscess scopic versus conventional appendectomy–a meta-analysis
formation to range from 1% in nonperforated appendicitis of randomized controlled trials. BMC Gastroenterol 2010
and 5 to 20% in perforated appendix. Previous studies Nov;10:129.
showed increased incidence of intraabdominal abscess 7. Vernon AH, Georgeson KE, Harmon CM. Pediatric laparo-
formation after LA in perforated appendicitis and this scopic appendectomy for acute appendicitis. Surg Endosc
2004 Jan;18(1):75-79.
is mainly due to spread of infected intaabdominal fluid 8. Phillips S, Walton JM, Chin I, Farrokhyar F, Fitzgerald P,
with gas insufflations. 2,6,17,18 But in contrast, other studies Cameron B. Ten-year experience with pediatric laparoscopic
20
concluded that LA is safer or equivalent 4,9,19,20,22 to OA appendectomy–are we getting better? J Pediatr Surg 2005
regarding the intraabdominal abscess formation. In our May;40(5):842-845.
study, the incidence of postoperative abscess formation 9. Canty TG Sr, Collins D, Losasso B, Lynch F, Brown C. Laparo-
was much more common in the OA; it was 2.5% in LA scopic appendectomy for simple and perforated appendicitis
and 14.6% in OA (p < 0.05). This improvement is due to in children: the procedure of choice? J Pediatr Surg 2000
Nov;35(11):1582-1585.
the ability to visualize the whole abdominal cavity and 10. Esposito C, Borzi P, Valla JS, Mekki M, Nouri A, Becmeur F,
perform proper peritoneal lavage and proper suction of Allal H, Settimi A, Shier F, Sabin MG, et al. Laparoscopic versus
the infected fluid. The risk of prolonged ileus and bowel open appendectomy in children: a retrospective comparative
obstruction ranges from 0.2 to 1.2%. 9,21,23,24 In our study study of 2332 cases. World J Surg 2007 Apr;31(4):750-755.
adhesive intestinal obstruction occur in one patient in 11. Zhang Z, Wang Y, Liu R, Zhao L, Liu H, Zhang J, Li G. Sys-
OA group and no one in the LA group. tematic review and meta-analysis of single incision versus
conventional laparoscopic appendectomy in children. J
In our study, the length of hospitalization was Pediatr Surg 2015 Sep;50(9):1600-1609.
decreased in the LA group, which is related to less pain, 12. St Peter SD, Adibe OO, Juang D, Sharp SW, Garey CL,
quicker ambulation, and early start of oral feeding, and Laituri CA, Murphy JP, Andrews WS, Sharp RJ, Snyder CL,
fewer complications, less pain as the muscle cutting et al. Single incision versus standard 3-port laparoscopic
incision in OA is much more painful compared with appendectomy. Ann Surg 2011 Oct;254(4):586-590.
muscle stretching port insertion. This also has been 13. Marzouk M, Khater M, Elsadek M, Abdelmoghny A. Laparo-
scopic versus open appendectomy: a prospective comparative
4
reported by several studies. In this study, OA patients study of 227 patients. Surg Endosc 2003 May;17(5):721-724.
had significantly more postoperative clinic visits than LA 14. Yau KK, Siu WT, Tang CN, Yang GP, Li MK. Laparoscopic
21
patients. Similar finding was also noticed by Taqi et al versus open appendectomy for complicated appendicitis. J
25
and Muncini et al and this was mainly related to Am Coll Surg 2007 Jul;205(1):60-65.
recurrent abdominal pain and follow-up for the infected 15. Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R.
wound. 10,13 Laparoscopic versus open appendectomy: a prospective
randomized double-blind study. Ann Surg 2005 Sep;242(3):
439-450.
CONCLUSION 16. Jen HC, Shew SB. Laparoscopic versus open appendectomy
In our study, we showed that LA for perforated appen- in children: outcomes comparison based on a statewide
analysis. J Surg Res 2010 Jun;161(1):13-17.
dicitis in children can be performed safely with a low 17. Bennett J, Boddy A, Rhodes M. Choice of approach for
incidence of complications and it offers children faster appendicectomy: a meta-analysis of open versus laparoscopic
recovery; so, we recommend LA in all cases of compli- appendicectomy. Surg Laparosc Endosc Percutan Tech 2007
cated appendicitis. Aug;17(4):245-255.
World Journal of Laparoscopic Surgery, January-April 2018;11(1):1-4 3