A Prospective Study Comparing Laparoscopic with Open Appendectomy in Children with Complicated Appendicitis

Abstract

Background: Due to the difficulty of performing minimally invasive surgery in a region of distorted anatomy and significant inflammation, the decision to do laparoscopic appendectomy in pediatric patients with complicated appendicitis has been controversial. The main advantages of laparoscopic appendectomy in complicated appendicitis, according to several studies, are wound infection avoidance and shorter hospital stays. The study’s goal is to investigate and compare various clinical outcomes in children with complicated appendicitis who were treated with laparoscopic appendectomy versus those treated with open appendectomy to determine the value of laparoscopic appendectomy in pediatric patients. Methods: A prospective randomized controlled clinical trial was done at a single center in TAIF, Saudi Arabia. The study included children aged 14 years or less who were diagnosed with complicated appendicitis. All collected preoperative findings, investigations, type of surgery, operative findings and time, postoperative complications, antibiotic course, length of hospital stay, time to start oral intake, and histopathology report were analyzed. Results: Operative time was significantly longer in the Laparoscopic Appendectomy (LA) group (73.1 min) than in the Open Appendectomy (OA) group (63.4min) (p=0.0344), while the total hospitalization duration was significantly shorter in the LA group (4.51days) in comparison with the OA group (5.94 days) (p=0.0001). In addition, a statistically significant difference was noted in the resumption of oral intake which was significantly faster in the LA vs OA group (2.1 days) vs (3.4 days) (p=0.0001). We observed that patients in the OA group had a higher rate of incidence of surgical site infection (SSI), which is statistically significant (p= 0.0389). Conclusions: Our study shows that laparoscopic appendectomy in the expert hands for the management of complicated appendicitis in the pediatric population is considered safe and feasible and should be considered a first choice. Keywords: Children, complicated appendicitis, open appendectomy, Laparoscopic Appendectomy.