Laparoscopic-assisted Appendectomy in Children with Uncomplicated Appendicitis

Background: Acute appendicitis is one of the common surgical emergencies in the pediatric population. In 1990, laparoscopic-assisted appendectomy was used in children for the first time. In this study, we present our initial experience with laparoscopic-assisted appendectomy in children, using two trocar sites, and assess it for safety and outcome. Methods: 76 cases with acute appendicitis underwent laparoscopic-assisted appendectomy at Salmaniya Medical Complex (SMC), Kingdom of Bahrain, between January 2012 and December 2015. These cases were reviewed prospectively. Results: 76 patients between 5 and 12 years underwent laparoscopic-assisted appendectomy at SMC. Operative time ranged from 25 to 45 min (mean 33.93 min). Postoperative hospitalization ranged from 2 to 5 days (mean 2.88 days). One patient developed wound infection which subsequently subsided with conservative treatment. One case was converted to open appendectomy, but without any intraoperative complications. All patients were followed up for 2 weeks, 1 month, and 3 months postoperatively. Conclusion: Laparoscopic-assisted appendectomy in children is a safe alternative to the open technique. The operative time in this technique and the length of hospitalization are both less and shorter than the open counterpart. No major intra-operative or postoperative complications were documented. Recovery was excellent. Keywords: Appendicitis, Laparoscopic-assisted appendectomy, Open appendectomy

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Transumbilical Laparoscopic-Assisted Appendectomy in the Treatment of Acute Uncomplicated Appendicitis in Children

Gastroenterology Research and Practice ◽

10.1155/2015/949162 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Carmine Noviello ◽

Mercedes Romano ◽

Ascanio Martino ◽

Giovanni Cobellis

Keyword(s):

Acute Appendicitis ◽

Operative Time ◽

Open Appendectomy ◽

Laparoscopic Technique ◽

Diffuse Peritonitis ◽

Histopathologic Examination ◽

Appendiceal Mass ◽

Uncomplicated Appendicitis ◽

The Mean ◽

Laparoscopic Assisted

Transumbilical laparoscopic-assisted appendectomy (TULAA) is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis) and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA). All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA) was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males) with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years). Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results).

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Changes in Incidence and Management of Acute Appendicitis in Children—A Population-Based Study in the Period 2000–2015

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1714655 ◽

2020 ◽

Author(s):

Grith Laerkholm Hansen ◽

Jakob Kleif ◽

Christian Jakobsen ◽

Anders Paerregaard

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Laparoscopic Appendectomy ◽

Pediatric Population ◽

Open Appendectomy ◽

Postoperative Mortality ◽

Population Based ◽

Postoperative Hospital Stay ◽

Population Based Study ◽

Registration System

Abstract Introduction Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark. Materials and Methods Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality. Results A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (–29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period. Conclusion In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.

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Clinical outcome of appendectomy: laparoscopic vs open technique

International Surgery Journal ◽

10.18203/2349-2902.isj20215137 ◽

2021 ◽

Vol 9 (1) ◽

pp. 93

Author(s):

Jan M. Rather ◽

Sobia Manzoor ◽

Mubashir Shah

Keyword(s):

Clinical Outcome ◽

Acute Appendicitis ◽

Standard Care ◽

Operative Time ◽

Open Appendectomy ◽

Laparoscopic Group ◽

Open Group ◽

Complication Rates ◽

Open Technique ◽

Duration Of Hospital Stay

Background: Acute appendicitis is a common abdominal surgical emergency. Appendectomy has been proven to be the standard care for the treatment of acute appendicitis. Objective of the study was to compare laparoscopic and open appendectomy in terms of clinical outcome and complication rates.Methods: This was a single centric, retrospective study conducted at SKIMS, Soura from May 2018 to April 2021. Open and laparoscopic appendectomy patients were compared in terms of operative times, conversion rate, complication rates and duration of hospital stay.Results: Total 120 patients were included in this study with 40 in laparoscopic group while 80 patients in the open group. Increased operative time in laparoscopic group (p=0.033) and longer duration of hospital stay (p=0.021) with open group while as comparable complication rate in both procedures were observed. Higher rates of intra-abdominal collection in laparoscopic group as compared to open groupConclusions: Both laparoscopic and open appendectomy procedures can be performed routinely for acute appendicitis without the additional risks of complications.

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Transumblical Single Incision Two-Port Laparoscopic Assisted Appendectomy: Early Experience in Paediatric Patients

TAJ Journal of Teachers Association ◽

10.3329/taj.v22i2.37747 ◽

2009 ◽

Vol 22 (2) ◽

pp. 289-294

Author(s):

MA Nowshad ◽

A Mostaque ◽

SMA Shahid ◽

HK Emrul

Keyword(s):

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Single Incision ◽

Open Appendectomy ◽

Operation Time ◽

Randomized Controlled ◽

Safe Technique ◽

Port System ◽

Laparoscopic Assisted ◽

Additional Port

Laparoscopic appendectomy considered as superior alternative to open appendectomy. Usual laparoscopic appendectomy is performed with the three port system. In this study, we performed a unique single transumblical incision two-port laparoscopic assisted appendectomy with the aim to reduce postoperative port site complication as well as improving cosmesis and patients satisfaction. From January 2010, 32 patients were admitted with clinically diagnosed acute appendicitis and were randomly assigned to single transumblical incision two-port laparoscopic assisted appendectomy. Transumblical single incision two-port laparoscopic assisted appendectomy was attempted in all patients (9 males and 23 females) with an average age of 9.2 years. Transumblical single incision two-port laparoscopic assisted appendectomy was successfully completed in 31 patients. In one patient, another additional port required due to severe adhesion of the appendix. Mean operation time was 25.2 minutes (range, 17-38), and mean postoperative hospital stay was 1.Sdays (range 1-2). Postoperative complications (local pericaecal abscess) occurred in one case that was treated conservatively. Transumblical single incision two-port laparoscopic assisted appendectomy appears to be a feasible and safe technique for the treatment of acute appendicitis in the paediatric setting. It allows nearly scar less abdominal surgery. The true benefit of the technique should be assessed by randomized controlled trials.TAJ 2009; 22(1): 289-294

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TO FIND THE INCIDENCE OF TYPE OF POST OPERATIVE WOUND INFECTION IN UNCOMPLICATED ACUTE APPENDICITIS CASES USING PROPHYLACTIC POST OPERATIVE ANTIBIOTICS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i2.927 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Vishal Prashar ◽

Shamsher Singh

Keyword(s):

Acute Appendicitis ◽

Wound Infection ◽

Open Appendectomy ◽

Cost Of Treatment ◽

Uncomplicated Appendicitis ◽

Randomized Control ◽

Uncomplicated Acute Appendicitis ◽

Abdominal Infections ◽

Control Prospective Study ◽

Operative Wound

Background: The efficacy of antibiotic prophylaxis in patients undergoing appendectomy has been examined in several randomized and observational studies showing that appropriate use of antibiotics reduces the risk of SSI following appendectomy by 40-60%. These antibiotics are continued in postoperative period with different courses and combinations according to each case. Methods: This randomized control prospective study was conducted in IGMC SHIMLA from August 2017 to July 2018. Cases of uncomplicated acute appendicitis undergoing emergency open appendectomy were included in this study. Results: All the 9 patients who had wound infection developed superficial surgical site infection. None of the patients developed deep surgical site or intra abdominal infections in either of the two groups. Conclusion: Frequency of post operative wound infection is generally very low in uncomplicated appendicitis. The prolonged use of antibiotics post operatively is unnecessary, can increase antibiotic resistance, can produce side effects and increase cost of treatment. Keywords: Wound infection, Antibiotic, Acute appendicitis.

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A retrospective study on laparoscopic appendectomy versus open appendectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20191127 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1144

Author(s):

P. Senthil Kumar ◽

S. Edwin Kin’s Raj ◽

Saranya Nagalingam

Keyword(s):

Retrospective Study ◽

Acute Appendicitis ◽

Hospital Stay ◽

Laparoscopic Appendectomy ◽

Operative Time ◽

Open Appendectomy ◽

Laparoscopic Approach ◽

Laparoscopic Group ◽

Daily Activities ◽

Early Return

Background: Appendectomy is the most common surgical procedure performed in emergency surgery. Open appendectomy is the “gold standard” for the treatment of acute appendicitis. Laparoscopic appendectomy though widely practiced has not gained universal approval. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a retrospective study.Methods: The study was done as a retrospective study among 387 patients diagnosed with appendicitis for a period of 18 months in the Dept of General Surgery. All patients included were 16 years and above and followed up for 3 weeks. In this study, 130 patients diagnosed as acute appendicitis - underwent open appendectomy and 257 patients diagnosed as sub-acute cases of appendicitis - underwent laparoscopic appendectomy. These two groups (open & laparoscopic) were compared for operative time, length of hospital stay, postoperative pain, complication rate, early return to normal activity.Results: Laparoscopic appendectomy was associated with a shorter hospital stay (around 4.5 days), with a less need for analgesia and with an early return to daily activities (around 11.5 days). Operative time was significantly shorter in the open group (35 mins), when compared with laparoscopic group (around 59 mins). Total number of complications was less in the Laparoscopic group with a significantly lower incidence of post-op pain and complications.Conclusions: The laparoscopic approach is a safe and efficient operative procedure and it provides clinically beneficial advantages over open appendectomy (including shorter hospital stay, an early return to daily activities and less post-op complications).

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P066: Outcomes of non-operative versus operative management in pediatric acute uncomplicated appendicitis

CJEM ◽

10.1017/cem.2017.268 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S100

Author(s):

W. Janjua ◽

A. Janjua ◽

E. Loubani ◽

N. Merritt ◽

K. Van Aarsen

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Pediatric Population ◽

Retrospective Chart Review ◽

Operative Management ◽

Final Diagnosis ◽

Uncomplicated Appendicitis ◽

Long Term Follow Up ◽

Ed Visits ◽

Non Operative Management

Introduction: The purpose of this study was to look at outcomes of pediatric patients with early, acute appendicitis who were treated with non-operative management (NOM) with antibiotics. Primary outcomes were subsequent appendectomy or Emergency Department (ED) visits. Methods: The method used for this study was a retrospective chart review of children under the age of 18, looking at outcomes of those who received non-operative management (NOM) for early acute appendicitis between April 2014-April 2015. The inclusion criteria included: (a) Age 0-17, (b) US or CT suggested acute uncomplicated appendicitis (c) Final diagnosis of appendicitis during April 2014-2015. Outcomes that were investigated were repeat ED visits and need for subsequent appendectomy. Results: Data extracted from the EMR found 209 charts with an ED diagnosis of appendicitis. Two charts (.9%) were excluded as they were duplicates. Sixty-seven patients (32%) were excluded after appendicitis was ruled out. One hundred and forty patients (67%) had a final diagnosis of appendicitis, 124 patients (88.6%) were taken directly to the operating room for appendectomy, 16 patients (11.4%) were treated with antibiotics instead of operative management. Three patients who received non-operative management had complex appendicitis, 13 had acute uncomplicated appendicitis. Six patients out of 13 (46%) were successfully treated with antibiotics with no repeat visits to the ED or Pediatric Surgery for appendectomy, 7 patients (54%) required appendectomy after initial treatment with antibiotics. Two patients who underwent appendectomy after initial NOM had no evidence of clinical appendicitis, one patient was taken to the OR based on parent preference and one patient had an episode of abdominal pain that prompted an interval appendectomy four weeks post the episode of abdominal pain. Conclusion: Treatment of acute uncomplicated appendicitis with NOM remains a management option in the pediatric population. Further studies and long term follow up are required to better identify appropriate patients for non-operative management versus operative management.

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Intracorporeal hybrid single port vs conventional laparoscopic appendectomy in children

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2016.133 ◽

2016 ◽

Vol 38 (3) ◽

Author(s):

Paul Anthony Karam ◽

Amy Hiuser ◽

David Magnuson ◽

Federico Gian Filippo Seifarth

Keyword(s):

Laparoscopic Appendectomy ◽

Single Port ◽

Intraoperative Complications ◽

Open Appendectomy ◽

Surgical Site Infections ◽

Hybrid Technique ◽

Modified Technique ◽

Effective Technique ◽

Operative Complications ◽

Laparoscopic Assisted

Transumbilical laparoscopic assisted appendectomy combines laparoscopic single port dissection with open appendectomy after exteriorization of the appendix through the port site. Compared to the conventional three-port approach, this technique provides an alternative with excellent cosmetic outcome. We developed a safe and effective technique to perform an intracorporeal single port appendectomy, using the same laparoscope employed in the extracorporeal procedure. Retrospective review of 71 consecutively performed intracorporeal single port appendectomies and 30 conventional three-port appendectomies in children 6 to 17 years of age. A straight 10-mm Storz telescope with inbuilt 6 mm working channel is used to dissect the appendix, combined with one port-less 2.3 mm percutaneous grasper. Polymer WECK® hem-o-lock® clips are applied to seal the base of the appendix and the appendiceal vessels. No intraoperative complications were reported with the hybrid intracorporeal single port appendectomy or three-port appendectomy. There were two post-operative complications in the group treated with the single port hybrid technique: one intra-abdominal abscess and one surgical site infection. Groups did not differ in age, weight, and types of appendicitis. Operative times were shorter for the hybrid technique (70 vs 79 minutes) but did not differ significantly (P=0.19). This modified technique to a previously described single port extracorporeal appendectomy is easy to master and implement. It provides exposure similar to a three-port laparoscopic appendectomy, while maintaining virtually scarless results and potentially reduces the risk for surgical site infections compared to the extracorporeal technique.

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Complications after Laparoscopic Appendectomy for Complicated Appendicitis

Lietuvos chirurgija ◽

10.15388/lietchirur.2020.19.23 ◽

2020 ◽

Vol 19 (1-2) ◽

pp. 34-41

Author(s):

Andrej Nikolovski ◽

Shenol Tahir ◽

Dragoslav Mladenovikj

Keyword(s):

Postoperative Complications ◽

Wound Infection ◽

Laparoscopic Appendectomy ◽

Operative Time ◽

Open Appendectomy ◽

Laparoscopic Group ◽

Complicated Appendicitis ◽

Open Group ◽

Uncomplicated Appendicitis ◽

Low Incidence

Background. Laparoscopic appendectomy is established method in the treatment of complicated appendicitis. Certain advantages of the technique do not fulfill the expectations for its superiority over the open appendectomy as when it is used for uncomplicated appendicitis. This is generally caused because of the high variety of postoperative complications reported in different series for complicated appendicitis. Material and methods. This prospective interventional clinical study analyzes 61 patients operated with laparoscopic and open appendectomy due to complicated appendicitis, with an end point of comparing the intra and postoperative complications in both groups. Results. Conversion in open appendectomy was forced in one patient (1.63%). The operative time was significantly shorter in the laparoscopic group (p = 0.048). Wound infection was significantly predominant in the open group (p = 0.045). Postoperative intraabdominal abscess occurred in one patient in the laparoscopic group (p = 0.52). The overall morbidity was 26.2% (7 patients in the laparoscopic, and 9 in the open group; p = 0.59). Length of stay was significantly shorter in the laparoscopic group (p = 0.00001). Conclusion. Certain significant advantages of the laparoscopic appendectomy as low incidence of wound infection, short hospitalization, less postoperative pain and faster socialization makes the laparoscopy up to date method in the treatment of complicated appendicitis.

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Comparative study of single incision versus conventional three port laparoscopic appendectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20184701 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3852 ◽

Cited By ~ 1

Author(s):

Sahil Rometra ◽

Rahil Rometra ◽

Neeraj Koul ◽

R. K. Chrungoo

Keyword(s):

Laparoscopic Surgery ◽

Acute Appendicitis ◽

Hospital Stay ◽

Laparoscopic Appendectomy ◽

Operative Time ◽

Single Incision ◽

Open Appendectomy ◽

Single Incision Laparoscopic Surgery ◽

Abdominal Incision ◽

Significant Difference

Background: Appendicitis is primarily a disease of adolescents and young adults with a peak incidence in the second and third decades of life. Appendectomy for appendicitis is the most commonly performed emergency operation in the world.For more than a century, open appendectomy remained the gold standard for the treatment of acute appendicitis. Laparoscopic surgery has become popular universally during the last couple of decades. Efforts are still being made to decrease abdominal incision and visible scars after laparoscopy. Single incision laparoscopic surgery (SILS) is a new innovation allowing minimal access surgery to be performed through a single umbilical incision.Methods: It was a prospective study carried out on 50 patients diagnosed as acute appendicitis. They were divided into two groups of 25 each. One group underwent Conventional Laparoscopic Appendectomy (CLA) and other group underwent Single Incision Laparoscopic Surgery (SILS). Results were compared with regard to mean operative time, complications, post-operative pain and discomfort (vas score at 12 hours), post-operative morbidity, duration of hospital stay and condition at discharge and cosmesis.Results: There was no statistically significant difference between the two groups with respect to the parameters like postoperative pain, hospital stay and complication profile. However, operative time for SILS appendectomy were found to be significantly higher compared to conventional group.Conclusions: Single incision laparoscopic appendectomy using standard laparoscopic instruments is safe and effective, feasible surgery with better cosmetic results.

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