Open Versus Laparoscopic Appendectomy In Children: A Comparison Of Outcomes

BACKGROUND/PURPOSE: Laparoscopic treatment of pediatric appendicitis remains controversial especially in cases of complications including perforated and gangrenous appendicitis and their attendant overall postoperative outcomes. This study evaluates the comparison of various outcomes in open (OA) and laparoscopic appendectomy (LA). METHODS: A retrospective chart reviewed was performed on 382 consecutive patients who underwent either pediatric laparoscopic or open appendectomy for diagnosis of acute appendicitis between January 2005 and December 2009. Data was reviewed for age, sex, weight, type and length of operating time, operative findings, complications, and length of stay and histology reports. RESULTS: A total of 382 cases of pediatric appendectomy were reviewed, 276 (72%) were performed as OA and 106 (28%) by LA. There were only six conversions (LA+OA) which were excluded from this analysis representing a conversion rate of 5.66%. The mean age for the open appendectomy group was 9.71 ± 2.91 versus 11.24 ± 2.11 for the laparoscopic group (P<0.001). Body weight was between 21 and 50kg in 204 patients (74%) in the OA group and in 72 (68%) in the LA group (P<0.01). The mean operating time was 38.0 ± 11.6 minutes for the OA group as against 45.7 ± 14.3 minutes in the LA group (P<0.0018). During surgery, 30 patients (10.9%) in the OA group and 10 (9.4%) in the LA group were found to have perforated appendicitis, while a gangrenous appendix was found in 24 patients (8.7%) of the OA group and in 3 (2.8%) of the LA group, resulting in a total of complicated appendicitis of 19.6% in the OA group and of 12.2% in the LA group. There were 26 postoperative complications; 23 (8.3%) in the OA group and 3 (2.8%) in the LA group (P<0.25). OA patients were hospitalized 3.49 ± 2.43 days on the average, while LA patients were hospitalized 2.71 ± 1.71 days (P<0.012). Histology was negative for 28 (10.1%) of the OA patients and for 16 (15%) of the LA patients (P<0.25), yielding a 25% negative appendectomy rate in total. CONCLUSION: These findings show that laparoscopic appendectomy is a safe and effective alternative in the management of pediatric appendicitis. This technique allows a complete visualization of the abdominal cavity enabling diagnosis and treatment of other abdominal pathologies. Less postoperative complications and shorter hospital stay were evident in this study, and early discharge did not appear to be influenced by age, gender or weight.