Abstract
Context: It remains, as yet, an issue unsettled by evidence that whether the younger age and smaller size of the pediatricpatient affect the efficacy of laparoscopy for appendicectomy and intraabdominal testes. Aims: To prospectively assess the level of difficulty, surgical stress and outcomes of two commonly done laparoscopic procedures i.e., appendicectomy and orchiopexy for intraabdominal testes, across the pediatric age and size spectrum. Settings and Design: Prospective interventional study conducted in Pediatric Surgery department of a tertiary hospital. Subjects and Methods: From April 2013 to August 2014, 60 children underwent either laparoscopic interval appendicectomy or orchiopexy (unilateral or bilateral) by same surgeon. Difficulty level, metabolic stress and other clinical outcomes of the laparoscopic procedures were compared across various age groups. Statistical Analysis: Kruskal-Wallis test was used to compare various age groups with respect to the study variables. Results: The patients were divided into three groups with age ranges of 1 - 6 years, 6 - 9 years and 9 - 13 years. The three groups were very different (P = 0.000) with respect to the body surface area of included children. Each of the three age groups had a similar set of 20 laparoscopic procedures viz., 10 appendicectomies, 8 unilateral orchiopexies and 2 bilateral orchiopexies. The three groups had no difference in the total level of difficulty score, duration of capnoperitoneum, postop increase in serum CRP and blood glucose levels (surrogates for metabolic stress sustained due to surgery), time to full orals and postop hospital stay. Conclusion: The younger age and smaller size of patient do not affect the efficacy of laparoscopic appendicectomy and orchiopexy.
Highlights
Laparoscopy is an increasingly popular surgical approach for appendicectomy and intraabdominal testis in children [1]
Surgeon-perceived difficulty level, patient-sustained metabolic stress and clinical outcomes of the laparoscopic approach for appendicectomy and intraabdominal testes were compared across the pediatric age and size spectrum
Kruskal-Wallis test was used for comparison of various variables among the three age groups and P-value < 0.05 was considered significant
Summary
Laparoscopy is an increasingly popular surgical approach for appendicectomy and intraabdominal testis in children [1]. It remains, as yet, an issue unsettled by evidence that whether the age and size of the patient affect the efficacy of laparoscopic approach for these procedures in younger and smaller children [2]. Due to the lack of evidence to the contrary, many pediatric surgeons may deprive the smaller children of the benefits of minimal access approach [2]. This study was designed to prospectively assess the level of difficulty, surgical stress and outcomes of two commonly done laparoscopic procedures i.e., appendicectomy and orchiopexy for intraabdominal testes, across the pediatric age and size (quantitated as body surface area) spectrum
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