LAPAROSCOPIC VERSUS OPEN APPENDECTOMY IN CHILDREN - COMPARATIVE-STUDYOF 403 CASES

Laparoscopic appendectomy (LA) has not achieved widespread acceptance among surgeons, open appendectomy (OA) being a simple and secure techn ique. We compared retrospectively 200 LAs and 203 OAs in children and adolescents (mean age = 10 years) from January 1, 1989, to March 31, 1 993. The introduction of LA did not modify our operative indications. Laparoscopic investigations found 22 right lower quadrant peritoneal a dhesion diseases (11%), those lesions were totally unknown with OA. Op erative complications are more frequent with LA (5% versus 1% - p < 0. 02): bleeding of the appendiculary artery or of an epigastric vessel, intestinal perforation and burn of the ileum are the most serious comp lications that we had. On the other hand, the postoperative complicati ons mostly occur after OAs (10.8% versus 1.5% - p < 0.001): 11 wound a bscesses, 8 intraperitoneal infections and 4 obstructions after OA and only 1 wound abscess and 2 intra peritoneal abscesses after LA. The g eneral anesthesia was significantly longer for LA (72 minutes vs 55 mi nutes - p < 0.001). Mean hospital stay was 4 days after LA and 6.4 day s after OA. The postoperative complications involved 27 additional hos pital days after LA and 162 days for OA. As a conclusion, OA is quicke r and has few operative complications. But LA has many advantages: les s traumatic, easy treatment of ectopic appendix, efficient lavage of t he peritoneum, less frequent postoperative complications and better po stoperative comfort. All this encourages us to go on with LA, all the more as the operative complications fall off with the training of the operator.