Although nonoperative treatment of appendicitis (NOTA) in the pediatric population has been well reported recently, patient selection and treatment scheme varies among studies, making it difficult to establish treatment standards for NOTA.
In a single medical center, patients younger than 18 years who were diagnosed with appendicitis: 1) with abdominal pain not exceeding 24 hours, 2) without radiologic evidence of appendicolith or appendiceal perforation or pelvic abscess, and 3) without signs of frank generalized peritonitis were offered NOTA, and their data were prospectively collected.
Twenty-two patients with uncomplicated appendicitis agreed to NOTA and were enrolled in the study. The initial success rate (resolution of abdominal pain and hospital discharge without appendectomy) was 100% (22 out of 22 patients). At a median follow-up period of 23.8 months, two patients had recurrence at two and three months after completion of NOTA. These patients underwent laparoscopic appendectomy.
Stringent patient selection may be necessary to apply NOTA safely for all children with uncomplicated appendicitis. Further studies concerning patient selection and conformed treatment protocols for NOTA are required.
Currently the substantial clinical benefits of single-port laparoscopic appendectomy (SLA) over conventional three-port laparoscopic appendectomy (CLA) are equivocal. The aim of this study was to compare surgical outcomes between SLA and CLA in children with acute appendicitis.
A single blind prospective randomized single center study was performed to compare the surgical outcomes of SLA and CLA. A total of 105 patients were randomized and various parameters were analyzed, 52 patients with SLA and 53 patients with CLA between July 2013 and March 2014. Patients with sonographically confirmed acute appendicitis were randomly assigned to receive either SLA or CLA. The outcome measurements were operating time, wound complication, and intraperitoneal morbidities, postoperative pain score and cosmetic result score.
Operating time is significantly longer in SLA (70.4±26.7 minutes vs. 58.0±23.4 minutes; p=0.016). There were no significant differences in the postoperative wound complication rate and intraperitoneal morbidities between two groups. There were no significant differences in postoperative resting pain score (6.6±2.5 vs. 6.3±2.5; p=0.317) and activity pain score (6.9±2.4 vs. 6.3±2.5; p=0.189), and the cosmetic result score (9.2±1.1 vs. 9.1±1.4; p=0.853).
Although SLA would be a safe and feasible procedure in children, SLA could not demonstrate the clear benefit over CLA.
Laparoscopic appendectomy (LA) has become a gold standard for children even in complicated appendicitis. The purpose of this study was to compare the postoperative surgical site infection rates between laparoscopic and open appendectomy (OA) group in pediatric complicated appendicitis.
A total of 1,158 pediatric patients (age ≤15 years) underwent operation for appendicitis over a period of 8 years. Among these patients, 274 patients (23.7%) were diagnosed with complicated appendicitis by radiologic, operative and pathologic findings, and their clinical outcomes were retrospectively analyzed.
Of the 274 patients with complicated appendicitis, 108 patients underwent LA and 166 patients underwent OA. Patients in the LA group returned to oral intake earlier (1.9 days vs. 2.7 days; p<0.01) and had a shorter hospital stay (5.0 days vs. 6.3 days; p<0.01). However, rate of postoperative intra-abdominal infection (organ/space surgical site infection) was higher in the LA group (LA 15/108 [13.9%] vs. OA 12/166 [7.2%]; p<0.01). Readmission rate was also higher in the LA group (LA 9/108 [8.3%] vs. OA 3/166 [1.8%]; p<0.01).
The minimally invasive laparoscopic technique has more advantages compared to the open procedure in terms of hospital stay and early recovery. However, intra-abdominal infection and readmission rates were higher in the laparoscopy group. Further studies should be performed to evaluate high rate of organ/space surgical infection rate of laparoscopic procedure in pediatric complicated appendicitis.
The entity of negative appendectomies still poses a dilemma in chlidren. Focused computed tomography (CT) scanning has become the diagnostic test of choice in many hospitals. However, the impact of CT scans on the diagnosis in children is unknown exactly. The purpose of this study was to critically evaluate CT scans for the evaluation of acute appendicitis in children, to review utilization of this diagnostic test in our appendicitis population and to determine if diagnostic accuracy has improved. A retrospective analysis of efficacy of CT scan for diagnosis of appendicitis in children was conducted. Children undergoing appendectomy for acute appendicitis were reviewed from 2007 to 2012. Perforation and negative appendectomy (removal of a normal appendix) rates were determined by the final pathologic report. Statistical comparison were made using the χ2 test and significance was assigned at
Appendicitis is the most common surgical emergency in childhood and the technologic advances of modern medicine have affected the diagnosis and treatment of appendicitis. This study is to evaluate the differences in diagnosis and treatment of appendicitis between present and 10 year ago. The authors retrospectively reviewed the medical records of patients who underwent appendectomy under the diagnosis of the acute appendicitis from July 1993 to June 1995 (Group A, n = 78) and from July 200 to June 2005 (Group B, n = 105). There are no differences between group A and B in mean age (8.5 ±3.6 vs. 9.3 ±3.1 year), duration of symptoms (3.0 ±3.2 vs. 2.6 ±3.8 days), and postoperative hospital stay(6.6 ±4.8 vs. 5.8 ±3.6 days). Preoperative abdominal ultrasonogram and/or computed tomogram was performed in 7 patients (9.0 %) of group A and in 51 patients (58.5 %) of group B. Thirty-six patients (34.3 %) of group B underwent laparoscopic appendectomy, but none in group A. Incidence of a histologically normal appendix decreased from 15.8 % in group A to 4.8 % in group B (p =0.018). This study suggests that utilization of abdominal ultrasonogram or computed tomogram in preoperative evaluation become more popular and surgical treatment of acute appendicitis become more minimally invasive. The rate of negative appendectomy was also reduced compared with 10 year ago.
Appendectomy is the most common emergency surgical operation in children. The laparoscopic treatment of pediatric appendicitis is controversial, particularly in complicated cases. The purpose of this study is to evaluate laparoscopic appendectomy (LA) and open appendectomy (OA) for simple and perforated appendicitis (SA, PA) in children. A total of 188 patients, operated from January 1992 to September 2003, were reviewed. Ninety-one patients underwent OA (65 SA and 26 PA) and 97 had LA ( 67 SA, 30 PA). There was one conversion of LA to OA in PA. Operative time for LA was longer for OA in PA (55.8 vs. 45.7 min; p=0.0467). Recovery of bowel movement, diet starting time, length of hospital stay for LA were significantly shorter than those for OA. Postoperative complication rate was not different between LA and OA in each group. Laparoscopic appendectomy is a safe and effective method for both simple and perforated appendicitis.
Appendicitis is the most common surgical emergency in childhood. Open techniques have been adopted in children after experiences in various surgical conditions in adults has accumulated. It is debatable whether Laparoscopic appendectomy (LA) is superior to open appendectomy (OA) in children. The goal of this study is to review the results of laparoscopy and laparotomy in the nonperforated appendicitis. The records of 22 patients under 15 years of age who were operated upon for nonperforated appendicitis at Asan Medical Center were analyzed between December 2002 and April 2003. Age, type and length of intervention, frequency of analgesic use, complication, length of hospitalization, and cost for each treatment groups (N=11) were compared. Laparoscopy patients were older (13.0 vs. 10.1 years; p > 0.05), and operative time was longer (55.0 vs. 35.0 minutes; p < 0.05). There was no conversion (OA to LA). The median length of hospital stay was significantly shorter in laparoscopy (3.0 vs. 2.0 days; p < 0.05). The median cost for LA was more expensive (W833, 836 vs. W751,398; p < 0.05). Even though there were higher costs and longer operative times with laparoscopic procedures, the shorter hospital stay was an advantage.
Laparoscopic appendectomy is relatively well-established as an alternative to conventional open appendectomy by many laparoscopic surgeons. However, experience in the pediatric population remains limited. Over a period of 2 years, a total of 155 pediatric patients with acute appendicitis or complicated appendicitis were studied to compare laparoscopic and open appendectomies in childhood. Laparoscopic appendectomy was attempted in 49 patients and completed in 48 patients(98.0%). Open appendectomy was performed in 107 patients. The severity of disease, age, and male to female ratio were similar in both groups. The operation time was shorter in the laparoscopic group than open group but the difference was not significant statistically(43.7±11.3 minutes versus 49.0±21.4 minutes, p=0.066). In the laparoscopic group, the mean duration of surgery for the former half patients was significantly longer than for the latter half(49.6±9.2 minutes versus 38.1±10.3 minutes, p=O.OOl). The mean number of doses of analgesia required postoperatively was significantly less in patients undergoing laparoscopic appendectomy(2.4±1.8 versus 3.3±2.5, p=0.021). There were only 2 (4.2%) wound infections after laparoscopic appendectomy compared with 10(9.3 %) complications including 7 wound infections, 1 intestinal obstruction, and 2 pulmonary complications after open appendectomy, but the difference was not significant( p=0.614). Patients undergoing laparoscopic appendectomy had a shorter period of hospitalization(3.2±2.2 days versus 6.4±1.6 days, p=O.OOl). The present study suggests that laparoscopic appendectomy shortens operating time and hospital stay with diminished postoperative pain. Laparoscopic appendectomy in children offers advantages over open appendectomy as noted in adults. The authors consider laparoscopic appendectomy to be the reasonable alternative to open appendectomy in children.
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