Background. Since the latter half of 1980s laparoscopy has become a well accepted modality in children in many surgical procedures including appendectomy. We present here the experience of laparoscopic appendectomy in children in a tertiary care hospital in Bangladesh.？？Subjects & Methods. From October 7, 2005 to July 31, 2012, 1809 laparoscopic appendectomies were performed. Laparoscopy was performed in all the cases using 3 ports. For difficult and adherent cases submucosal appendectomy was performed. Feeding was allowed 6？h after surgery and the majority was discharged on the first postoperative day. The age, sex, operative techniques, operative findings, operative time, hospital stay, outcome, and complications were evaluated in this retrospective study. Results. Mean age was 8.17？±？3.28 years and 69% were males. Fifteen percent were complicated appendicitis, 8 cases needed conversion, and 27 cases were done by submucosal technique. Mean operating time was 39.8？±？14.2 minutes and mean postoperative hospital stay was 1.91 days. About 5% cases had postoperative complications including 4 intra-abdominal abscesses. Conclusions. Laparoscopic appendectomy is a safe procedure in children even in complicated cases. 1. Introduction Semm, a German Gynecologist, first described the method of laparoscopic appendectomy in adults [1]. Since then a series of reports came out with restrained enthusiasm for laparoscopy [2–6]. In children, the doubts were more pronounced especially in complicated cases [7–11]. However practice of laparoscopy increased with passage of time and its superiority over open technique is now well established in terms of morbidity, recovery, wound infections, hospital stay, and utility in young females and obese children [6, 12–15]. Nowadays single incision laparoscopy is also being practiced [13]. We describe here our experience with laparoscopic appendectomy in children of Bangladesh using conventional 3 port techniques. 2. Subjects and Methods From October 7, 2005 to July 31, 2012, 1809 laparoscopic appendectomies were performed. Diagnoses were based on clinical suspicion as well as on ultrasonogram findings. Under general endotracheal anesthesia, laparoscopy was performed in all the cases. Patients were supine with monitor on the right side and surgeon on the left side of midsection of patient’s body. Assistant stood on the right side of surgeon towards head-end of patient. Three ports were placed: supraumbilical port for telescope, one port just medial to and below the left anterior superior iliac spine, and another just above and to
References
[1]
K. Semm, “Endoscopic appendectomy,” Endoscopy, vol. 15, no. 2, pp. 59–64, 1983.
[2]
P. F. Leahy, “Technique of laparoscopic appendicectomy,” British Journal of Surgery, vol. 76, no. 6, p. 616, 1989.
[3]
G. M. E. Humphrey and A. Najmaldin, “Laparoscopic appendicectomy in childhood,” Pediatric Surgery International, vol. 10, no. 2-3, pp. 86–89, 1995.
[4]
J. S. Valla, B. Limonne, V. Valla et al., “Laparoscopic appendectomy in children: report of 465 cases,” Surgical Laparoscopy & Endoscopy, vol. 1, no. 3, pp. 166–172, 1991.
[5]
A. Pier, F. Gotz, C. Bacher, and R. Ibald, “Laparoscopic appendectomy,” World Journal of Surgery, vol. 17, no. 1, pp. 29–33, 1993.
[6]
S. Laine, A. Rantala, R. Gullichsen, and J. Ovaska, “Laparoscopic appendectomy—is it worthwhile? A prospective, randomized study in young women,” Surgical Endoscopy, vol. 11, no. 2, pp. 95–97, 1997.
[7]
A.-N. Meguerditchian, P. Prasil, R. Cloutier, S. Leclerc, J. Peloquin, and G. Roy, “Laparoscopic appendectomy in children: a favorable alternative in simple and complicated appendicitis,” Journal of Pediatric Surgery, vol. 37, no. 5, pp. 695–698, 2002.
[8]
O. Aziz, T. Athanasiou, P. P. Tekkis et al., “Laparoscopic versus open appendectomy in children: a meta-analysis,” Annals of Surgery, vol. 243, no. 1, pp. 17–27, 2006.
[9]
A. M. Ingraham, M. E. Cohen, K. Y. Bilimoria, T. A. Pritts, C. Y. Ko, and T. J. Esposito, “Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals,” Surgery, vol. 148, no. 4, pp. 625–637, 2010.
[10]
J. R. Horwitz, M. D. Custer, B. H. May, J. R. Mehall, and K. P. Lally, “Should laparoscopic appendectomy be avoided for complicated appendicitis in children?” Journal of Pediatric Surgery, vol. 32, no. 11, pp. 1601–1603, 1997.
[11]
O. Faiz, S. C. Blackburn, J. Clark et al., “Laparoscopic and conventional appendicectomy in children: outcomes in English hospitals between 1996 and 2006,” Pediatric Surgery International, vol. 24, no. 11, pp. 1223–1227, 2008.
[12]
H. C. Jen and S. B. Shew, “Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis,” Journal of Surgical Research, vol. 161, no. 1, pp. 13–17, 2010.
[13]
A. Moazzez, R. J. Mason, and N. Katkhouda, “Laparoscopic appendectomy: new concepts,” World Journal of Surgery, vol. 35, no. 7, pp. 1515–1518, 2011.
[14]
X. Li, J. Zhang, L. Sang et al., “Laparoscopic versus conventional appendectomy—a meta-analysis of randomized controlled trials,” BMC Gastroenterology, vol. 10, article 129, 2010.
[15]
T. M. Schmelzer, A. R. Rana, K. C. Walters, H. J. Norton, D. A. Bambini, and B. T. Heniford, “Improved outcomes for laparoscopic appendectomy compared with open appendectomy in the pediatric population,” Journal of Laparoendoscopic and Advanced Surgical Techniques, vol. 17, no. 5, pp. 693–697, 2007.
[16]
M. J. Hannan and M. M. Hoque, “Laparoscopic submucosal appendectomy for difficult and adherent cases: a novel technique to minimize complications,” Journal of Laparoendoscopic & Advanced Surgical Techniques, vol. 22, no. 10, pp. 1017–1020, 2012.
[17]
A. B. Johnson and M. E. Peetz, “Laparoscopic appendectomy is an acceptable alternative for the treatment of perforated appendicitis,” Surgical Endoscopy, vol. 12, no. 7, pp. 940–943, 1998.
[18]
N. Katkhouda, R. J. Mason, S. Towfigh et al., “Laparoscopic versus open appendectomy: a prospective randomized double-blind study,” Annals of Surgery, vol. 242, no. 3, pp. 439–450, 2005.
[19]
R. S. Chung, D. Y. Rowland, P. Li, and J. Diaz, “A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy,” American Journal of Surgery, vol. 177, no. 3, pp. 250–256, 1999.
[20]
B. Kutasy, M. Hunziker, G. Laxamanadass, and P. Puri, “Laparoscopic appendectomy is associated with lower morbidity in extremely obese children,” Pediatric Surgery International, vol. 27, no. 5, pp. 533–536, 2011.
[21]
B. Wei, C.-L. Qi, T.-F. Chen et al., “Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis,” Surgical Endoscopy and Other Interventional Techniques, vol. 25, no. 4, pp. 1199–1208, 2011.
[22]
B. Banieghbal, S. Al-Hindi, and M. R. Q. Davies, “Laparoscopic appendectomy with appendix mass in children,” Pediatric Endosurgery and Innovative Techniques, vol. 8, no. 1, pp. 25–30, 2004.
[23]
G. Piskun, D. Kozik, S. Rajpal, G. Shaftan, and R. Fogler, “Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis,” Surgical Endoscopy, vol. 15, no. 7, pp. 660–662, 2001.
[24]
M. Ben Dhaou, S. Ghorbel, T. Chouikh et al., “Conservative management of post-appendicectomy intra-abdominal abscesses,” Italian journal of pediatrics, vol. 36, p. 68, 2010.
[25]
R. McKinlay, S. Neeleman, R. Klein et al., “Intraabdominal abscess following open and laparoscopic appendectomy in the pediatric population,” Surgical Endoscopy and Other Interventional Techniques, vol. 17, no. 5, pp. 730–733, 2003.
[26]
G. J. Mancini, M. L. Mancini, H. S. Nelson Jr. et al., “Efficacy of laparoscopic appendectomy in appendicitis with peritonitis,” American Surgeon, vol. 71, no. 1, pp. 1–5, 2005.
[27]
C. G. Ball, J. B. Kortbeek, A. W. Kirkpatrick, and P. Mitchell, “Laparoscopic appendectomy for complicated appendicitis: an evaluation of postoperative factors,” Surgical Endoscopy and Other Interventional Techniques, vol. 18, no. 6, pp. 969–973, 2004.
[28]
H.-F. Lin, J.-M. Wu, L.-M. Tseng, K.-H. Chen, S.-H. Huang, and I.-R. Lai, “Laparoscopic versus open appendectomy for perforated appendicitis,” Journal of Gastrointestinal Surgery, vol. 10, no. 6, pp. 906–910, 2006.
[29]
S. R. Markar, S. Blackburn, R. Cobb et al., “Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children,” Journal of Gastrointestinal Surgery, vol. 16, no. 10, pp. 1993–2004, 2012.
