Vol. 9 No. 1 (2017): Archives of Public Health
Clinical Science

Laparoscopic appendectomy in children in Republic of Macedonia

Ристо Симеонов
University Clinic for Children Surgery, Medical Faculty, Sts. Cyril and Methodius University, Skopje

Published 2017-08-19

How to Cite

1.
Симеонов Ристо. Laparoscopic appendectomy in children in Republic of Macedonia. Arch Pub Health [Internet]. 2017 Aug. 19 [cited 2024 Mar. 28];9(1):26-34. Available from: https://www.id-press.eu/aph/article/view/1257

Abstract

Acute appendicitis is very common acute surgical condition in childhood that  requires quick and safe treatment with least possible complications. Тhe aim of the paper was to evaluate the initial experience of the application of laparoscopic appendectomy (LA)  in pediatric patients with acute appendicitis. Material and methods: This is adescriptive study comprising clinical material of the first 15 pediatric cases clinically diagnosed with acute appendicitis and treated with LA at the University Clinic of Pediatric Surgery in Skopje in the period 2013/14. Results: From the total of 15 children treated with LA, 10 (66.7%) were male. The average duration of laparoscopic appendectomy was 43.9±7.1 minutes, with a minimum duration of 30 and maximum of 60 minutes. Postoperative time to the start of peristalsis was 4.5±0.8 hours and the time to the first gas discharge was 4.7±1.3 hours. Fluids and food intake started after 8.9±1.5 vs. 11.2±1.8 hours respectively, with 50% of patients doing that 10 IQR  (8-10) or 12 IQR  (10-12) hours after surgery. The average hospitalization was 2.9±0.7 days, and 50% of children stayed less than 3 IQR (2-3) days.  Treatment with analgetics/antibiotics lasted 1.4±0.5 vs. 2.7±0.5 days, respectively. The average scars size was 3.5±0.3 mm. Pathohistological verification corresponded with the macroscopic appearance. In all patients, LA was completed without conversion. No postoperative or delayed complications were registered. Conclusion:  LA is a safe and effective technique for treatment of acute appendicitis with advantages in terms of reduced postoperative pain, reduced hospitalization and a rapid return to normal activities. Although this is our initial experience with LA in children, it is comparable to world literature. With good training, improved surgical technique, LA will increasingly become the surgical procedure of choice in the treatment of acute appendicitis in children.

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References

  1. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of ap- pendicitis and appendectomy in the United States. Am J Epidemiol
  2. ;132:910-925.
  3. Hua J, Gong J, Xu B, et al. Single-in- cision versus conventional laparo- scopic appendectomy: a meta-analy- sis of randomized controlled trials. J Gastrointest Surg 2014; 18: 426-436.
  4. McBurney C. The incision made in the abdominal wall in cases of ap- pendicitis, with a description of a new method of operating. Ann Surg
  5. ;20:38-43.
  6. Connor TJ, Garcha IS, Ramshaw BJ, et al. Diagnostic laparoscopy for suspected appendicitis. Am Surg
  7. ;61:187-189.
  8. Miyauchi Y, Sato M, Hattori K. Com- parison of outcomes between single incision laparoscopic appendectomy and conventional laparoscopic ap- pendectomy in children. J Laparoen- dosc Adv Surg Tech A. 2011.
  9. Bergholz R, Klein I, Wenke K, et al.
  10. Midterm outcome of trans umbilical- ly laparoscopic-assisted versus lap- aroscopic and open appendectomy in children"”a matched prospective study. Eur J Pediatr Surg 2014; 25:
  11. -219.
  12. Semm K. Endoscopic appendectomy.
  13. Endoscopy 1983;15:59-64.
  14. Aziz MI, van der Burg BL, Hamming JF. Laparoscopic versus open appen- dectomy in children: a meta-analy- sis. Ann Surg 2006;243:17–27.
  15. Markar SR, Karthikesalingam A, Di Franco F, et al. Systematic review and meta-analysis of single-incision versus conventional multiport ap- pendicectomy. Br J Surg 2013; 100:
  16. -1718.
  17. Miyauchi Y, Sato M, Fau - Hattori K, et al. Comparison of postoperative pain between single-incision and conventional laparoscopic appen- dectomy in children. Asian J Endosc Surg 2014; 7: 237-240.
  18. Kang DB, Lee SH, Lee SY, et al. Ap- plication of single incision laparo- scopic surgery for appendectomy in children. J Korean Surg Soc 2012; 82:
  19. -115.
  20. Langness SM, Hill SJ, Wulkan ML Single-site laparoscopic appendecto- my: a comparison to traditional lap- aroscopic technique in children. Am Surg 2011; 77: 961-964.
  21. Padilla BE, Dominguez G, Millan C, et al. Initial experience with mag- net-assisted single trocar appendec- tomy in children. J Laparoendosc Adv Surg Tech A. 2013; 23: 463-466.
  22. Varlet F, Tardieu D, Limonne B, Metafiot H, Chavrier Y. Laparoscopic versus open appendectomy in chil- dren - comparative study of 403 cas- es. Eur J Pediatr Surg1994; 4: 333–337.
  23. Pier A, Gotz F, Bacher C. Laparo- scopic appendectomy in 625 cases: from innovation to routine. Surg Laparosc Endosc 1991;1: 8–13.
  24. Guller U, Hervey S, Purves H, Muhl- baier LH, Peterson ED, et al. Laparo- scopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg 2004; 239: 43–52.
  25. Heikkinen TJ, Haukipuro K, Hulk- ko A. Cost-effective appendectomy. Open or laparoscopic? A prospec- tive randomized study. SurgEndosc
  26. ;12:1204-1208.
  27. Lintula H, Kokki H, Vanamo K, Val- tonen H, Mattila M, Eskelinen M. The costs and effects of laparoscop- ic appendectomy in children. Arch Pediatr Adolesc Med. 2004;158:34-37.
  28. Cai YL, Xiong XZ, Wu SJ, et al. Sin- gle-incision laparoscopic appendec- tomy vs conventional laparoscopic
  29. appendectomy: systematic review and meta-analysis. World J Gastro- enterol 2013; 19: 5165-5173.
  30. Kaplan M, Salman B, Yilmaz TU, Oguz M. A quality of life comparison of laparoscopic and open approach- es in acute appendicitis: a rand- omized prospective study. Acta Chir Belg 2009; 109:356-363.
  31. Long KH, Bannon MP, Zietlow SP at al. A prospective randomized com- parison of laparoscopic appendecto- my with open appendectomy: clini- cal and economic analyses. Surgery
  32. ;129:390-400.
  33. Vernon AH, Georgeson KE, Harmon CM. Pediatric laparoscopic appen- dectomy for acute appendicitis. Sur- gEndosc 2004;18:75-79.
  34. Frazee RC, Bohannon WT. Lapa- roscopic appendectomy for com- plicated appendicitis. Arch Surg
  35. ;131:509-511.
  36. Varlet F, Tardieu D, Limonne B, Metafiot H, Chavrier Y. Laparoscopic versus open appendectomy in chil- dren – comparative study of 403 cas- es. Eur J Pediatr Surg 1994;4:333-337.
  37. Antoniou S.A., Koch O.O., Antoniou G.A., et al. Meta-analysis of rand- omized trials on single-incision lap- aroscopic versus conventional lapa- roscopic appendectomy. Am J Surg
  38. ; 207: 613-622.
  39. Stringel G. Appendicitis in children: a systematic approach for a low in- cidence of complications. Am J Surg
  40. ;154:631-635.
  41. Heinzelmann M, Simmen HP, Cum- mins AS, Largiader F. Is laparoscopic appendectomy the new "gold stand- ard"? Arch Surg1995;130:782-785.
  42. Lejus C, Delile L, Plattner V, et al.
  43. Randomized, single-blinded trial of laparoscopic versus open appendec- tomy in children: effects on postop- erative analgesia. Anesthesiology
  44. ;84:801-806.
  45. Klingler A, Henle KP, Beller S, Rech- ner J, Zerz A, Wetscher GJ, Szinicz G. Laparoscopic appendectomy does not change the incidence of post op- erative infectious complications. Am J Surg 1998;175:232-235.
  46. Chandler NM, Ghazarian SR, King
  47. TM, et al. Cosmetic outcomes fol- lowing appendectomy in children: a comparison of surgical techniques. J Laparoendosc Adv Surg Tech A 2014;
  48. : 584-588.
  49. Simon P, Burkhardt U, Sack U, Kai- sers UX, Muensterer OJ. Inflamma- tory response is no different in chil- dren randomized to laparoscopic or open appendectomy. J Laparoendosc Adv Surg Tech A 2009;19:S71-6.
  50. Lavonius MI, Liesjarvi S, Ovaska J, Pa- julo O, Ristkari S, Alanen M. Laparo- scopic versus open appendectomy in children: a prospective randomised study. Eur J PediatrSurg 2001;11:235-
  51. Lejus C, Delile L, Plattner V, Baron M, Guillou S, Héloury Y, Souron R. Randomized, single-blinded trial of laparoscopic versus open appendec- tomy in children: effects on postop- erative analgesia. Anesthesiology
  52. ; 84:801-806.
  53. Grewal H, Sweat J, Vazquez WD: Lap-
  54. aroscopic appendectomy in children can be done as a fast-track or same- day surgery. JSLS. 2004;8:151-154.
  55. Aziz O, Athanasiou T, Tekkis PP, et al. Laparoscopic versus open appen- dectomy in children: a meta-analy- sis. Ann Surg. 2006; 243: 17-27.
  56. Esposito C, Calvo AI, Castagnetti M, et al. Open versus laparoscopic ap- pendectomy in the pediatric popula- tion: a literature review and analy- sis of complications. J Laparoendosc Adv Surg Tech A 2012; 22: 834-839.