The comparative analysis of the open and laparoscopic appendectomy in children
DOI:
https://doi.org/10.15574/PS.2019.65.43Keywords:
children, acute appendicitis, appendectomy, laparoscopyAbstract
Laparoscopic appendectomy step-by-step widely introduced in the practice of pediatric surgeons. Besides of the well-known advantages of mini-invasive interventions, the expediency of laparoscopic appendectomy in children still debated.Aim of the work was to compare the results of open (OA) and laparoscopic appendectomy (LA) based on the own experience.
Materials and Methods. This study based on the results of surgical treatment of 3171 children with acute appendicitis, which were operated in 1st surgical department of Lviv regional clinical hospital «OXMATDYT» during 2009-2018 years. OA was applied in 2879 (90.8%) and LA – in 292 (9.2%) of patients. We analyzed the following data: accuracy of intraoperative diagnosis, duration of surgery, antibiotics therapy at the postoperative period and postoperative ileus; complications in the early postoperative period. Besides that, the results at the remote period were evaluated in 1032 (32.5%) of patients.
Results. The accuracy of the intraoperative diagnostic of the form of appendicitis was higher in case of LA compared with OA – 68.8% and 59.3%, respectively. Duration of LA was longer than OA, however this difference statistically was insignificant (р>0.05). The restoration of the gut motility was faster after LA vs. OA – at 21.52±1.39 and 29.5±0.68 hours, respectively. It’s determined the earlier starting of the enteral nutrition – at 1.22±0.57 and 2.32±0.72 days, respectively. The complications’ frequency in the early postoperative period had no statistical difference in cases of LA and OA, by that LA associated with the decreasing of the negative consequences and complications at the remote period.
Conclusions. LA accompanied by the faster restoration of the gut function that promoted for the earlier start of enteral nutrition and abolishing of antibacterial therapy. According to the frequency of complications both methods had no significant differences at the early postoperative period, however in LA these complications are less. At the follow-up, LA associated with the significant decrease of the quantity of negative consequences and complications.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.
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