Laparoscopic appendectomy for simple and perforated appendicitis in children: The procedure of choice?

Background/Purpose: Whether laparoscopic appendectomy (LA) is superior to o pen appendectomy (OA) for simple (SA) and perforated appendicitis (PA) in c hildren is debatable. The operative experience of 4 senior pediatric surgeo ns at a single institution was studied over a 6-year period during a transi tion from OA in all cases to LA in all cases, to answer this question. Methods: All appendectomies from December 1993 to December 1999 were review ed for operative technique (OA, LA), presence of perforation (SA, PA), oper ating time (OT), length of stay (LOS), morbidity, and mortality. Results: There were 1,128 appendectomies in children aged 14 months to 19 y ears, including 955 LA (653 in SA, 302 in PA) and 173 OA (86 in SA, 87 in P A). OT was equal for LA and OA in SA (52 minutes), but has dropped to less than 40 minutes for LA in the past year. OT in PA was slightly longer in LA versus OA (68 v. 58 minutes; P < .001) but recently has dropped in LA to l ess than 60 minutes. LOS in SA was 2 days for LA and 3 days for OA; in PA, LOS was 7 days in both LA and OA, but has dropped to 5 days for LA recently . Postoperative abscess rates and incidence of bowel obstruction did not di ffer between LA and OA in either group. There was no mortality. Conclusions: LA is at least as safe and effective as, if not superior to, O A for both simple and perforated appendicitis. Postoperative pain is less, and recovery is faster, thereby reducing LOS and overall cost. The growing demand for this procedure can be satisfied without increase in cost, morbid ity, or mortality. Laparoscopic appendectomy is our procedure of choice in children. Copyright (C) 2000 by W.B. Saunders Company.