The safety of laparoscopic appendectomy in complicated appendicitis in children.

Background: Laparoscopic Appendectomy (LA) is no longer a new procedure in pediatric surgery. In many pediatric surgery centers, laparoscopic management of acute appendicitis is practiced but we have observed that most of them performed laparoscopic appendectomy for simple straight forward appendicitis. It is generally considered that complicated appendicitis is better managed by an open procedure. The objective of this study was to establish safety of laparoscopic appendectomy in complicated appendicitis in children. Methods: Research was conducted at the Department of Pediatric Surgery, Shifa International Hospital Islamabad. Duration of study was 3 years after due approval from the ethical and research review board. Medical records of 42 patients who were operated on for complicated appendicitis laparoscopically at Shifa International Hospital, Islamabad from January 2018 to December 2020 was reviewed. All patients were enrolled from the emergency department. Clinical assessment of the patients was done in a routine way by history and physical examination. Investigations included complete blood count, C reactive protein and ultrasound abdomen and pelvis. Patients who had simple uncomplicated appendicitis, who had open appendectomy, and those who had laparotomy for other reasons were excluded from the study. All those patients who had complicated appendicitis like perforation, abscess, mass, or gangrene were included in the study. Variables observed in this study were age, gender, operative findings, operative time, hospital stay and postoperative complications. Results: The mean age of the patients was 9.95 ±3.22 years. Of 42 patients, 32 (76%) patients were male and 10 (24%) were female. Mean operative time was 42.5 ±20.03 minutes. Mean hospital stay was 2.23 ±1.55 days. Out of 42 patients, 20 (48%) had perforated appendicitis, 9 (21%) patients had appendicular mass, 12 (29%) patients had appendicular abscess, and 1 (2%) patient had gangrenous appendicitis. Postoperatively, one patient of perforated appendicitis had trocar site infection. One patient who had appendicular mass developed urinary retention with periorbital puffiness postoperatively. Two patients of appendicular mass had transaction of appendicular base due to perforated and sloughed appendicular base. One patient with an appendicular abscess had a large collection in the right paracolic gutter. One patient of appendicular abscess developed peritonitis with abscess formation secondary to cecal perforation. Conclusion: Laparoscopy for complicated appendicitis is safe in children with only fewer complications. Despite our limited experience of laparoscopic appendectomy, we believe that laparoscopy may safely be done as a first choice in all patients with appendicitis, whether simple or complicated. [ABSTRACT FROM AUTHOR]