Abstract
Background
In adult patients, it is generally accepted that laparoscopic appendicectomy (LA) is the predominant operative pathway in treating acute appendicitis. The case for a similar pathway utilising LA in children is less clear. We investigate usage, trends and complications after LA in children in a single co-located adult/paediatric centre with contemporaneous adults as controls.
Methods
A retrospective case–control study was conducted over 12 years including patients who underwent appendicectomy, and the paediatric series (<16 years) was divided into age-groups-based quartiles. An anonymous questionnaire-based national survey was circulated among general and paediatric surgeons.
Results
Of the 5784 appendicectomy patients, 2960 were children. LA rate in paediatric appendicitis was 65%. Yearly trends in LA reached a steady state in both groups after 2010 (Δ 0–1%/year). Rates of LA and LA IAA (respectively) differed significantly between age groups: 60, 3% (0–9 years); 65, 1% (10–13 years); 71, 2% (14–16 years) and 93, 3% (>16 years) (p = 0.001, 0.02). The national survey showed respondents believed LA was not superior to OA in paediatric patients except in terms of cosmesis. There was strong support in the use of LA in older children and children >40 kg.
Conclusion
The use of LA in paediatric appendicectomies in the study region is similar to international rates, but not increasing over time. Irish surgeons still favour OA in younger children and prefer a case-by-case approach rather LA being the preferred pathway. This is despite the regional and international evidence showing favourable outcomes with LA in children.
Similar content being viewed by others
References
Alvarez C, Voitk AJ (2000) The road to ambulatory laparoscopic management of perforated appendicitis. Am J Surg 179(1):63–66
Lin YY, Shabbir A, So JB (2010) Laparoscopic appendectomy by residents: evaluating outcomes and learning curve. Surg Endosc 24(1):125–130
Neugebauer E, Troidl H, Kum CK, Eypasch E, Miserez M, Paul A (1995) The E.A.E.S. consensus development conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements–September 1994. The Educational Committee of the European Association for endoscopic surgery. Surg Endosc 9(5):550–563
Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, Li ZZ, Wang H, Zhang H, Lin ZF et al (2015) Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc 29(6):1384–1393
Katkhouda N, Friedlander MH, Grant SW, Achanta KK, Essani R, Paik P, Velmahos G, Campos G, Mason R, Mavor E (2000) Intraabdominal abscess rate after laparoscopic appendectomy. Am J Surg 180(6):456–459 discussion 460–451
Allemann P, Probst H, Demartines N, Schafer M (2011) Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis–the role of routine abdominal drainage. Langenbecks Arch Surg 396(1):63–68
Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242(3):439–450
Markar SR, Blackburn S, Cobb R, Karthikesalingam A, Evans J, Kinross J, Faiz O (2012) Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 16(10):1993–2004
Sahm M, Kube R, Schmidt S, Ritter C, Pross M, Lippert H (2011) Current analysis of endoloops in appendiceal stump closure. Surg Endosc 25(1):124–129
St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D, Lanning D, Murphy JP, Andrews WS, Sharp RJ et al (2012) Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 256(4):581–585
Masoomi H, Nguyen NT, Dolich MO, Mills S, Carmichael JC, Stamos MJ (2014) Laparoscopic appendectomy trends and outcomes in the United States: data from the Nationwide Inpatient Sample (NIS), 2004–2011. Am Surg 80(10):1074–1077
Liu Y, Cui Z, Zhang R (2017) Laparoscopic versus open appendectomy for acute appendicitis in children. Indian Pediatr 54(11):938–941
Shah A (2008) A decade of minimal access pediatric surgery in India. J Indian Assoc Pediatric Surg 13(4):123–124. https://doi.org/10.4103/0971-9261.44760
Aziz O, Athanasiou T, Tekkis PP, Purkayastha S, Haddow J, Malinovski V, Paraskeva P, Darzi A (2006) Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg 243(1):17–27
Lee SL, Yaghoubian A, Kaji A (2011) Laparoscopic vs open appendectomy in children: outcomes comparison based on age, sex, and perforation status. Arch Surg (Chic Ill 1960) 146(10):1118–1121
Kapischke M, Pries A, Caliebe A (2013) Short term and long term results after open vs. laparoscopic appendectomy in childhood and adolescence: a subgroup analysis. BMC Pediatrics 13:154
Nataraja RM, Loukogeorgakis SP, Sherwood WJ, Clarke SA, Haddad MJ (2013) The incidence of intraabdominal abscess formation following laparoscopic appendicectomy in children: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 23(9):795–802
Nataraja RM, Teague WJ, Galea J, Moore L, Haddad MJ, Tsang T, Khurana S, Clarke SA (2012) Comparison of intraabdominal abscess formation after laparoscopic and open appendicectomies in children. J Pediatric Surg 47(2):317–321
Sweeney KJ, Dillon M, Johnston SM, Keane FB, Conlon KC (2006) Training in laparoscopic appendectomy. World J Surg 30(3):358–363. https://doi.org/10.1007/s00268-005-0311-7
Hospital In-Patient Enquiry. https://www.hiqa.ie/healthcare/health-information/data-collections/online-catalogue/hospital-patient-enquiry. Accessed 07 Dec16
Chiu CC, Wei PL, Wang W, Chen RJ, Chen TC, Lee WJ, Huang MT (2006) Role of appendectomy in laparoscopic training. J Laparoendosc Adv Surg Tech A 16(2):113–118
http://ec.europa.eu/eurostat/statistics-explained/index.phpSurgical_operations_and_procedures_statistics. Accessed 29 Nov 15
York D, Smith A, von Allmen D, Phillips JD (2006) Laparoscopic appendectomy in children after the learning curve. JSLS J Soc Laparoendosc Surg 10(4):447–452
Robertson I, Costello M, Shea N, Khan I, Waldron RM, Khan W, Barry K (2016) Management of paediatric acute appendicitis in the general hospital setting: a national survey of preferred surgical technique. Irish J Med Sci 185(1):63–67
Tam PK (2000) Laparoscopic surgery in children. Arch Dis Childhood 82(3):240–243
http://www.jcst.org/quality-assurance/documents/cct-guidelines/general-surgery-cct-guidelines. Accessed 29 Nov 16
Oka T, Kurkchubasche AG, Bussey JG, Wesselhoeft CW Jr, Tracy TF Jr, Luks FI (2004) Open and laparoscopic appendectomy are equally safe and acceptable in children. Surg Endosc 18(2):242–245
Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, Stamos MJ (2012) Comparison of outcomes of laparoscopic versus open appendectomy in children: data from the Nationwide Inpatient Sample (NIS), 2006–2008. World J Surg 36(3):573–578. https://doi.org/10.1007/s00268-011-1417-8
Guana R, Lonati L, Garofalo S, Tommasoni N, Ferrero L, Cerrina A, Lemini R, Dallan C, Schleef J (2016) Laparoscopic versus open surgery in complicated appendicitis in children less than 5 years old: a six-year single-centre experience. Surg Res Pract 2016:5
Krisher SL, Browne A, Dibbins A, Tkacz N, Curci M (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136(4):438–441
Reid RI, Dobbs BR, Frizelle FA (1999) Risk factors for post-appendicectomy intra-abdominal abscess. Aust N Z J Surg 69(5):373–374
Author information
Authors and Affiliations
Corresponding author
Additional information
Meetings: British Association of Paediatric Surgeons (BAPS) 2017.
Appendix 1: The appendix survey
Appendix 1: The appendix survey
Rights and permissions
About this article
Cite this article
Bhatt, N.R., Dunne, E., Faraz, M. et al. Trends in the Use of Laparoscopic Versus Open Paediatric Appendicectomy: A Regional 12-Year Study and a National Survey. World J Surg 42, 3792–3802 (2018). https://doi.org/10.1007/s00268-018-4688-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-018-4688-5