Safety of Laparoscopic Appendectomy in Complicated Appendicitis in children

Abstract

ABSTRACT
 INTRODUCTION: Acute appendicitis is one of the most common surgical emergency in pediatric age group. Laparoscopic Appendectomy (LA) is no more a new procedure in pediatric surgery. The idea behind laparoscopy is short hospital stay, minimal complications and better cosmesis especially in overweight and obese patients. Laparoscopy offers detailed and magnified visualization and better access into the whole abdominal cavity. In many pediatric surgery centers, laparoscopic management of acute appendicitis is practiced but we have observed that most of them performed laparoscopic appendectomy for simple straight forward appendicitis. It is generally considered that complicated appendicitis is better managed by open procedure. We have performed laparoscopy in 42 patients of Complicated Appendicitis (CA) and observed that the rate of complication is comparable to the known reported studies.
 OBJECTIVE: The objective of this study was to establish safety of laparoscopic appendectomy in complicated appendicitis in children
 STUDY DESIGN: It was a retrospective study.
 SETTING: Research was conducted at Department of Pediatric Surgery, Shifa International Hospital Islamabad.
 DURATION: Duration of study was 3 years after due approval from ethical and research review board.
 MATERIAL AND METHODS: The present study is a retrospective analytical review of 42 patients who were operated for complicated appendicitis laparoscopically at Shifa International Hospital, Islamabad from January 2018 to December 2020.
 All patients were enrolled from emergency department. Clinical assessment of the patients were done in the routine way by history and physical examination. Investigations included complete blood count, C reactive protein and ultrasound abdomen and pelvis. Those patients were excluded from the study who had simple non-complicated appendicitis, open appendectomy, those who had laparotomy for other reasons and interval appendectomy. Similarly those patients who were COVID positive were excluded from the study.
 All those patients who had complicated appendix like perforation, abscess, mass or gangrene were included in the study.
 Variables observed in this study were age, sex, operative findings, operative time, hospital stay and post op complications.
 RESULTS: From January 2018 to December 2020, total 42 patients were included in this study who underwent laparoscopic appendectomy for complicated appendicitis. Complicated appendicitis includes perforated appendicitis, abscess, mass or gangrene. Mean age of the patients was 9.95 with standard deviation of 3.22. Of 42 patients in total, 32 (76%) patients were male and 10 (24%) were female. Mean operative time was 42.5min with standard deviation of 20.03. Mean hospital stay time was 2.23 days with standard deviation of 1.55 (table 1).
 Out of total 42 patients, 20 (48%) had perforated appendicitis, 9 (21%) patients had appendicular mass, 12 (29%) patients had appendicular abscess and 1 (2%) patient had gangrenous appendicitis. Postoperatively, one patient of perforated appendicitis had trocar site infection. One patient had mass formation with partial obstruction and post-operatively developed urinary retention with peri-orbital puffiness. Two patients of appendicular mass had transaction of appendicular base due to perforated and sloughed appendicular base. One patient of appendicular abscess had large collection in right paracolic gutter. One patient of appendicular abscess developed peritonitis with abscess formation secondary to cecal perforation.
 CONCLUSION: Our experience with laparoscopy in appendicitis revealed that for complicated appendix laparoscopy is very safe in children with only fewer complications. Although our sample size is small but in our 3 last year experience we learned that laparoscopy may safely be done as a first choice in all patients with appendicitis, whether simple or complicated. Our experience indicates that the apprehension amongst the treating surgeons is not very justified as we routinely do laparoscopy in all appendicitis.
 KEY WORDS: Laparoscopic appendectomy, complicated appendicitis.