Laparoscopic Versus Open Appendectomy in Children with Complicated Appendicitis in a Tertiary Teaching Hospital
Abstract
Background: Acute appendicitis in children is the
most common surgical emergency. Good outcomes
have been reported with laparoscopic appendecto-
my (LA) in children for uncomplicated appendicitis.
But the use of laparoscopy for complicated appen-
dicitis in children is more controversial. Higher in-
cidences of postoperative abdominal and wound
infections have been reported. The purpose of this
study was to compare LA and open appendectomy
(OA) for complicated appendicitis in children.
Methodology: This was a prospective study con-
ducted by the department of Pediatric surgery over
a period of 4 years from January 2015 to January
2019. All the children with complicated appendicitis
were included in the study (perforation with local-
ised/generalised abscess, appendicular, gangrenous
appendix). Children with simple appendicitis were
excluded from the study. In the study period 80 chil-
dren presented with complicated appendicitis. 40
children underwent open appendectomy and re-
maining 40 underwent laparoscopic appendectomy.
Data
collection included demographics, duration of symp-
toms, type of complicated appendicitis, operative
time, resumption of diet, early and late complica-
tion, length of hospitalization and duration of anti-
biotic use. The documented benefits of the laparo-
scopic appendectomy (LA) procedure have led to its
increasing acceptance for the treatment of appendi-
citis, it is nonetheless considered more expensive to
perform than a traditional open appendectomy (OA)
[1]. There are persistent doubts about the advantag-
es and disadvantages in using LA for complicated ap-
pendicitis[2].
Although adopted by many centers as a gold stan-
dard, benefits of LA over OA are still in debate by
many surgeons. This may be attributed to the sim-
plicity of OA – which is relatively easy to perform –
low morbidity and cosmetic problems are low. Many
studies failed to demonstrate the benefits of LA com-
pared to OA, but this might be explained by the fact
that these studies were performed in the learning
period[3],[4].
Recently many studies show that LA provides consid-
erable benefits over OA, including a shorter hospital
stay, less postoperative pain, earlier postoperative
recovery, and lower complication rate[5].
The introduction of laparoscopy provides an oppor-
tunity to visualize the entire abdominal cavity in cas-
es of diagnostic dilemmas[6].
The aim of this study was to compare between LA
and OA in complicated acute appendicitis to deter-
mine which procedure is better. Data were fed to
the computer and analyzed using IBM SPSS software
package version 20.0 (IBM Corp., Armonk, New York,
USA). Qualitative data were described using number
and percentage. The Kolmogorov–Smirnov test was
used to verify the normality of distribution. Quan-
titative data were described using range (minimum
and maximum), mean, SD, and median. Significance
of the obtained results was judged at the 5% level.
Patients and methods: After the ethical commit-
tee’s approval and informed consent, a prospective
equivalence randomized study was conducted on 40
patients with suspected complicated acute appendi-
citis, and the equivalence study was randomly sub-
mitted to OA or LA. The suspicion of acute appendi-
