SHOULD LAPAROSCOPIC APPENDECTOMY BE AVOIDED FOR COMPLICATED APPENDICITIS IN CHILDREN

Background/Purpose: Laparoscopic appendectomy is becoming the preferre d technique for treating acute appendicitis. However, recent literatur e on adults suggests that laparoscopic appendectomy may increase the r isk for postoperative infectious complications in complicated (gangren ous or perforated) cases. This study was undertaken to compare the res ults of open versus laparoscopic appendectomy for complicated appendic itis in children. Methods: A retrospective review from two institution s was performed for all children treated operatively for complicated a ppendicitis from January 1994 through November 1996. Results: Fifty-si x cases were identified, Twenty-seven children underwent laparoscopic appendectomy, whereas 22 underwent open appendectomy, Seven children u nderwent conversion from laparoscopic to open surgery. Operating times and length of hospital stay did not differ signficantly between the l aparoscopic and open groups. Postoperative complications developed in 24 children (42.8%). Complications were more frequent after laparoscop ic appendectomy compared with open appendectomy (56% v 18%, P = .002). A postoperative intraabdominal absess (IAA) developed in 14 children (25%). An IAA occurred in two children after open appendectomy compare d with 11 children after laparoscopic appendectomy (9% v 41%, P = .01) . Conclusion: The findings suggest that laparoscopic appendectomy shou ld be avoided in children who have complicated appendicitis because of the increased risk for postoperative intraabdominal abscesses, The au thors propose a prospective, randomized trial to verify this finding. Copyright (C) 1997 by W.B. Saunders Company.