Laparoscopic Versus Open Appendectomy in Pediatric Patients with Complicated Appendicitis

摘要

Objective: to compare laparoscopic and open appendectomy in acute complicated appendicitis in pediatric population. Material and methods. The study included 250 children with acute complicated appendicitis, operated from December 2012 to August 2019 (164 laparoscopic, 60 open and 26 converting appendectomies). Most patients were 13-17 years old (101 cases, 40.4%). Perforated appendicitis was most often detected (47.6% of cases, 119 out of 250). In prevalence, in most cases there was spilled appendicular peritonitis (40.5%). Results. A significantly low incidence of early complications was revealed in the group of laparoscopic appendectomies (15.2% versus 56.7%; p 0.05), however, the hospital stay was reduced by 5.4 days with laparoscopy (9.3±2.6 versus 14.9±3.2 days, p<0.05) compared with similar indicators in the open appendectomy group. In the second period of the study (2016-2019), compared with the first (2012-2015), it was possible to increase the incidence of good long-term outcomes from 57.7% to 78.3% and reduce the frequency of bad outcomes from 9.2% to 2.5%. Conclusion. Improvement of tactical and technical approaches and the active introduction of endovisual technologies in the surgery of acute complicated appendicitis in children made it possible significantly reduce the frequency of postoperative specific and general complications, and significantly increase the incidence of good long-term outcomes.