Experience with laparoscopy in the surgical treatment of acute appendicitis in children
DOI:
https://doi.org/10.15574/PS.2025.4(89).6575Keywords:
acute appendicitis, laparoscopic appendectomy, children, complications, conversion, peritonitis, drainageAbstract
Acute appendicitis (AA) is the most common cause of emergency surgical interventions in children. Laparoscopic appendectomy (LA) has gradually become the first-choice method due to its effectiveness and the minimized postoperative period.
Aim - to analyze the surgical technique, advantages, and indications for LA, clinical outcomes, efficacy, safety, complications, and postoperative recovery in the surgical treatment of AA in children.
Materials and methods. Medical records of inpatients, surgical protocols, histological examination results, and postoperative course dynamics were analyzed in 699 pediatric patients with AA who underwent a total of 701 surgical interventions. Of these, 600 (85.6%) were laparoscopic appendectomies (LA), 18 (2.6%) were conversions, 81 (11.6%) were open appendectomies (OA), and 2 (0.3%) were relaparotomies.
Results. The use of LA made it possible to gradually replace OA in over 91% of AA cases, while conversion rates ranged from 0 to 4.8% due to destructive forms and anatomical anomalies. Over the course of refining the LA technique, the average operation time decreased from 67.8 to 37.4 minutes, and postoperative treatment duration was reduced from 4.3 to 2.1 days. Destructive forms of AA accounted for 83.2% of cases, and peritonitis was present in 19.5% (58.0% of which were treated with LA). Intraoperative complications during LA (11.2%) mainly included omental injuries. The most common early postoperative complication following LA was the presence of the phrenicus symptom, and relaparotomy was performed in 0.3% of cases. Abdominal cavity drainage was performed in 5.7% of operations. All patients were discharged in a recovered state.
Conclusions. LA has become the first-line method for surgical treatment of AA in children, performed in over 91% of cases, leading to reduced operation time and shorter postoperative recovery compared to OA. A well-considered laparoscopic assessment of the specific intraoperative situation allows for a justified decision to convert, thereby preventing critical complications during and after surgery.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents.
The authors declare no conflict of interest.
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