Skip to main content
Log in

Laparoscopic Versus Open Appendectomy for Acute Appendicitis in Children: a Nationwide Retrospective Study on Postoperative Outcomes

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Purpose

Our aim was to compare postoperative outcomes of laparoscopic and open appendectomies for acute appendicitis in children under the circumstance of widespread use of laparoscopic surgery.

Method

This study included data on laparoscopic and open appendectomies in children with acute appendicitis from the National Clinical Database, which is a Japanese nationwide surgical database, in 2015. The occurrence rates of complications within 30 days after the surgery and postoperative hospital stay were compared by univariate and multivariate analyses. p < 0.05 was considered statistically significant.

Results

This study included 4489 appendectomies, of which 3166 surgeries (70.5%) were performed laparoscopically. Appendectomy was performed for complicated and uncomplicated appendicitis in 1765 (39.3%) and 2724 cases (60.7%), respectively. Postoperative complications within 30 days were observed in 246 operations (5.5%). Organ-space surgical site infection (SSI), deep wound SSIs, and superficial wound SSIs were observed in 2.3%, 1.0%, and 2.4% of operations, respectively. On multivariate analysis, the incidence of postoperative complications (odds ratio 1.21, 95% CI 0.90–1.64, p = 0.207) and the length of hospital stay (median 4 days in both groups, p = 0.835) were not significantly different between patients who underwent laparoscopic or open appendectomy. Subgroup analysis in complicated and uncomplicated appendicitis cases also demonstrated no significant differences in the incidence of postoperative complications between those who underwent laparoscopic or open appendectomy.

Conclusion

This study suggested that the occurrence of postoperative complication and the length of hospital stay in pediatric patients who underwent laparoscopic appendectomy are similar with those in pediatric patients who underwent open appendectomy for acute appendicitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Canty TG, Sr., Collins D, Losasso B, Lynch F, Brown C. Laparoscopic appendectomy for simple and perforated appendicitis in children: the procedure of choice? J Pediatr Surg. 2000;35:1582–5.

    Article  Google Scholar 

  2. McKinlay R, Neeleman S, Klein R, Stevens K, Greenfeld J, Ghory M et al. Intraabdominal abscess following open and laparoscopic appendectomy in the pediatric population. Surg Endosc. 2003;17:730–3.

    Article  CAS  Google Scholar 

  3. Varlet F, Tardieu D, Limonne B, Metafiot H, Chavrier Y. Laparoscopic versus open appendectomy in children--comparative study of 403 cases. Eur J Pediatr Surg. 1994;4:333–7.

    Article  CAS  Google Scholar 

  4. Dai L, Shuai J. Laparoscopic versus open appendectomy in adults and children: A meta-analysis of randomized controlled trials. United European Gastroenterol J. 2017;5:542–53.

    Article  Google Scholar 

  5. Page AJ, Pollock JD, Perez S, Davis SS, Lin E, Sweeney JF. Laparoscopic versus open appendectomy: an analysis of outcomes in 17,199 patients using ACS/NSQIP. J Gastrointest Surg. 2010;14:1955–62.

    Article  Google Scholar 

  6. Aziz O, Athanasiou T, Tekkis PP, Purkayastha S, Haddow J, Malinovski V et al. Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg. 2006;243:17–27.

    Article  Google Scholar 

  7. Gotoh M, Miyata H, Hashimoto H, Wakabayashi G, Konno H, Miyakawa S et al. National Clinical Database feedback implementation for quality improvement of cancer treatment in Japan: from good to great through transparency. Surg Today. 2016;46:38–47.

    Article  Google Scholar 

  8. The National Clnical Database http://www.ncd.or.jp/. 2018. Accessed 2/21/2018 2018.

  9. Markar SR, Blackburn S, Cobb R, Karthikesalingam A, Evans J, Kinross J et al. Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg. 2012;16:1993–2004.

    Article  Google Scholar 

  10. Gosemann JH, Lange A, Zeidler J, Blaser J, Dingemann C, Ure BM et al. Appendectomy in the pediatric population-a German nationwide cohort analysis. Langenbecks Arch Surg. 2016;401:651–9.

    Article  Google Scholar 

  11. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;6.

  12. Jen HC, Shew SB. Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis. J Surg Res. 2010;161:13–7.

    Article  Google Scholar 

  13. Kelly KN, Fleming FJ, Aquina CT, Probst CP, Noyes K, Pegoli W et al. Disease severity, not operative approach, drives organ space infection after pediatric appendectomy. Ann Surg. 2014;260:466–71.

    Article  Google Scholar 

  14. Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT et al. Comparison of outcomes of laparoscopic versus open appendectomy in children: data from the Nationwide Inpatient Sample (NIS), 2006-2008. World J Surg. 2012;36:573–8.

    Article  Google Scholar 

  15. Murata A, Mayumi T, Muramatsu K, Ohtani M, Matsuda S. Effect of hospital volume on outcomes of laparoscopic appendectomy for acute appendicitis: an observational study. J Gastrointest Surg. 2015;19:897–904.

    Article  Google Scholar 

  16. Smink DS, Finkelstein JA, Kleinman K, Fishman SJ. The effect of hospital volume of pediatric appendectomies on the misdiagnosis of appendicitis in children. Pediatrics. 2004;113:18–23.

    Article  Google Scholar 

  17. Smink DS, Fishman SJ, Kleinman K, Finkelstein JA. Effects of race, insurance status, and hospital volume on perforated appendicitis in children. Pediatrics. 2005;115:920–5.

    Article  Google Scholar 

  18. Wei PL, Liu SP, Keller JJ, Lin HC. Volume-outcome relation for acute appendicitis: evidence from a nationwide population-based study. PLoS One. 2012;7:26.

    Google Scholar 

Download references

Presentation at a Scientific Meeting

This paper was based on an abstract presented at the 51st annual scientific meeting of the Pacific Association of Pediatric Surgeons, May 13–17, 2018, in Sapporo, Japan.

Funding

This work was supported by JSPS KAKENHI (Grant-in-Aid for Scientific Research (C) Grant Number JP16K11340).

Author information

Authors and Affiliations

Authors

Contributions

Conception of the study: JF, EW, TI. Analysis and interpretation: JF, EW, NH, KT, HT, HM. Drafting the manuscript: JF. Reviewing the manuscript: JF, EW, NH, KT, HT, TI, HM.

Corresponding author

Correspondence to Jun Fujishiro.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujishiro, J., Watanabe, E., Hirahara, N. et al. Laparoscopic Versus Open Appendectomy for Acute Appendicitis in Children: a Nationwide Retrospective Study on Postoperative Outcomes. J Gastrointest Surg 25, 1036–1044 (2021). https://doi.org/10.1007/s11605-020-04544-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-020-04544-3

Keywords

Navigation