[Appendectomy in children: laparoscopic or open approach?]

Abstract

Introduction: Many data are reachable in international literature according to the advantages and disadvantages of laparoscopic or open appendectomies. Objective: The aim of this study was to evaluate laparoscopic versus open appendectomy in childhood based on a single-center experience. Method: A retrospective observational cohort study was conducted on children (0–18 years) who were operated between 2011 and 2020 in a single institute. The patients were divided into two groups: laparoscopic and open appendectomy (including converted laparoscopy). Co-morbidities were excluded. Patients were also divided into two groups based on the histological results: uncomplicated (negative, simplex, catarrhal, phlegmonous, gangrenous) and complicated acute appendicitis (perforated) cases. Postoperative complications (wound healing problems, intra-abdominal abscess, ileus) and length of hospital stay were analyzed. For statistical analyses, Fisher’s exact, chi2 for trend and Mann–Whitney U tests were used. Results: Altogether 1444 patients who underwent appendectomies (602 laparoscopic, 842 open) were investigated. The mean age at the time of operation was 10.93 (SD 3.49) years. Complications were observed in 45 out of 602 patients (7.48%) who underwent laparoscopy and in 83 out of 842 patients (9.86%) who underwent open operation (p = 0.1163). The median length of hospital stay in patients after laparoscopy was 3 (2; 4) days; whereas following open approach it was 4 (3; 5) days (p<0.0001). In uncomplicated cases, the median of length of hospital stay was 3 (2; 3) days after laparoscopy and 3 (3; 5) days after open approach (p<0.0001). In complicated cases, the median length of hospital stay was 8 (6; 10) days after laparoscopy and 8 (7; 10) days following open approach, respectively (p = 0.0202). Discussion: The international literature is replete with data on the advantages and disadvantages of laparoscopic versus open appendectomy. Conclusion: The study concludes that both laparoscopic and open appendectomies are safe methods for treating children with acute appendicitis, with no difference in complications. However, the hospital stay is significantly shorter following a laparoscopic procedure. Orv Hetil. 2024; 165(19): 742–746.