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.

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.