Abstract
Purpose
Although a national guideline has been implemented, the optimal approach for appendectomy in children remains subject of debate in the Netherlands. Opponents of laparoscopy raise their concerns regarding its use in complex appendicitis as it is reported to be associated with an increased incidence of intra-abdominal abscesses. The aim of this study was to evaluate the outcome of surgical approaches in both simple and complex appendicitis in paediatric patients.
Methods
A 10-year retrospective cohort study was performed (2001–2010) in paediatric patients treated for suspected acute appendicitis. Patients were divided into either simple or complex appendicitis and into different age groups. Primary outcome parameters were complication rate (intra-abdominal abscess (IAA), superficial surgical site infection (SSI) and readmission) and hospital stay.
Results
In total, 878 patients have been treated (median age 12, range 0–17 years). Two-thirds of the patients younger than 6 years had complex appendicitis, compared to one quarter in the group aged 13–18. In the complex appendicitis group, LA was associated with more IAA and early readmissions. In the simple appendicitis group, the complication rate was comparable between the two approaches. Significantly more IAAs were seen after LA in the youngest age group.
Conclusion
This study demonstrates the unfavourable outcome of LA in the youngest age group and in patients with complex appendicitis. Therefore, we advise to treat these patients with an open approach.
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Acknowledgments
All the authors contributed to the collection and analysis of the data and to the preparation of the report. The corresponding author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Part of this material has been presented at the spring meeting of the Association of Surgeons from the Netherlands (ASN), (‘‘Chirurgendagen’’), 10 and 11 May 2012, Veldhoven, the Netherlands and the presented abstract had been published in British Journal of Surgery. This current manuscript concerns an expansion of previous work.
Conflict of interest
The authors declare no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments. For this type of study, formal consent is not required.
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van den Boom, A.L., Gorter, R.R., van Haard, P.M.M. et al. The impact of disease severity, age and surgical approach on the outcome of acute appendicitis in children. Pediatr Surg Int 31, 339–345 (2015). https://doi.org/10.1007/s00383-015-3677-0
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DOI: https://doi.org/10.1007/s00383-015-3677-0