Laparoscopic versus open appendectomy in pediatric patients: Operative and postoperative experience

Toni Risteski; Rozeta Sokolova; Shaban Memeti; Risto Simeonov

doi:10.5281/zenodo.7101223

Authors

Toni Risteski University Clinic for Pediatric Surgery, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, Republic of N. Macedonia https://orcid.org/0000-0002-6678-7403
Rozeta Sokolova University Clinic for Pediatric Surgery, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, Republic of N. Macedonia https://orcid.org/0000-0002-0217-6224
Shaban Memeti University Clinic for Pediatric Surgery, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, Republic of N. Macedonia https://orcid.org/0000-0003-4620-9670
Risto Simeonov Acibadem Sistina Hospital, Skopje, Republic of N. Macedonia https://orcid.org/0000-0003-0583-1156

DOI:

https://doi.org/10.5281/zenodo.7101223

Keywords:

Acute appendicitis, children, laparoscopic appendectomy, open appendectomy, postoperative effects

Abstract

Abstract

Objective: Acute appendicitis is very frequently encountered in children. Despite many scientific controversies in supporting classical or laparoscopic appendectomy, there is still no official consensus on this issue. This study aimed to present our experience from the comparison of operative and postoperative effects of laparoscopic and open appendectomy in pediatric patients with acute appendicitis.

Materials and methods: The analytical cross-sectional study was conducted at the University Clinic for Pediatric Surgery, Ss. Cyril and Methodius University in Skopje, the Republic of N.Macedonia during the period 2015/2022. The study sample covered 184 hospitalized pediatric patients aged 4-14 years treated with laparoscopic (LA) or open appendectomy (OA). The data of interest included demographic characteristics, and selective operative and postoperative parameters.

Results: The average age of the children in LA vs. OA group was 9.63±2.70 with min/max of 4/14 vs. 9.16±2.91 with min/max 2/14 respectively. Postoperative complications were detected in 1 (0.90%) of LA patients and 3 (4.11%) of OA patients with no significant association. Analgesics’ treatment received 57 (51.35%) of the children from LA group and all of the children from OA group. Conversion from LA to OA happen only in 1 (0.54%) child. The evaluation of parents/guardians related to the satisfaction from the cosmetic appearance of the scar the significantly higher level of satisfaction from the scare after LA compared to OA intervention.

Conclusions: Laparoscopic appendectomy was found to be feasible and comparable to open approach in terms of operative time and offers advantages over the latter in terms of postoperative pain, length of hospital stay and earlier return of bowel function to normal. It is a safe approach in all types of appendicitis, with an overall better complication profile than OA.

References

Stringer MD. Acute appendicitis. J Paediatr Child Health. 2017;53(11):1071-6.

Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, et al. Comparison of outcomes of laparoscopic versus open appendectomy in adults: data from the Nationwide Inpatient Sample (NIS), 2006–2008. J Gastrointest Surg. 2011;15(12):2226-31.

Yaghoubian A, Kaji AH, Lee SL. Laparoscopic versus open appendectomy: outcomes analysis. Am Surg. 2012;78(10):1083-6.

Esposito C, Borzi P, Valla JS, Mekki M, Nouri A, Becmeur F, et al. Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World J Surg. 2007;31(4):750-5.

Taqi E, Al Hadher S, Ryckman J, Su W, Aspirot A, Puligandla P, et al. Outcome of laparoscopic appendectomy for perforated appendicitis in children. J Pediatr Surg. 2008;43(5):893-5.

Pogorelic Z, Buljubasic M, Susnjar T, Jukic M, Pericic TP, Juric I. Comparison of open and laparoscopic appendectomy in children: A 5-year single center experience. Indian Pediatr. 2019;56(4):299-303.

Little DC, Custer MD, May BH, Blalock SE, Cooney DR. Laparoscopic appendectomy: an unnecessary and expensive procedure in children? J Pediatr Surg. 2002;37(3):310-7.

Younes AE. A Prospective Study Comparing Laparoscopic with Open Appendectomy in Children with Complicated Appendicitis. Middle East Journal of Family Medicine. 2022;7(10):92.

Verdú MB, Mata DP, Sánchez AG, Roig AC, Palacios EC, Proaño S, et al. Re-interventions following appendectomy in children: a multicenter study. Cir Pediatr. 2022;35(2):70-4.

Low ZX, Bonney GK, So JBY, Loh DL, Ng JJ. Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis. Surg Endosc. 2019;33(12):4066-4077.

Murali GS, Misra R, Parashar G, Santhanakrishnan R. Does laparoscopic appendectomy confer advantages over open appendectomy for pediatric CA? A single institute experience. Indian J Child Health. 2020;7(2):74-77.

Falchi D, Bakır AC, Risteski T, Tziam HA, Yüksel S, Azizoğlu SI. Diagnostic Value of The Ischemia Modified Albumin and Pentraxin 3 In Pediatric Appendicitis: A Meta-Analysis. J Clin Tri Exp Invest. 2022;1(1):1-9.

Kassem R, Shreef K, Khalifa M. Effects and clinical outcomes of laparoscopic appendectomy in young children with CA: a case series. Egyptian J Surg. 2017;36:152-5.

Takami T, Yamaguchi T, Yoshitake H, Hatano K, Kataoka N, Tomita M, et al. A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study. Eur J Trauma Emerg Surg. 2020;46(4):847-851.

Zhang S, Du T, Jiang X, Song C. Laparoscopic appendectomy in children with perforated appendicitis: a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2017;27(4):262–6.

Seqsaqa M, Rozeik A.E, Khalifa M, Ashri HNA. Laparoscopic versus open appendectomy in complicated appendicitis in children: a single center study. Egyptian Pediatr Assoc Gaz. 2020;68(1):1-5

Sreekantamurthy P, Chinmayee B, Sharath. Laparoscopic versus open appendectomy in children with CA in a tertiary teaching hospital. Int Surg J. 2020;7(7):2213-7.

Khirallah MG, Eldesouki NI, Elzanaty AA, Ismail KA, Arafa MA. Laparoscopic versus open appendectomy in children with CA. Ann Pediatr Surg. 2017;13(1):17-20.

Basuguy E, Okur MH, Arslan S, Aydoğdu B, Akdeniz S, Azizoğlu M. Çocuklarda torakoport yardımlı laparoskopik apendektomi sonuçlarımız. Dicle Med J. 2020;47(3):727-34.

Neogi S, Banerjee A, Panda SS, Ratan SK, Narang R. Laparoscopic versus open appendicectomy for complicated appendicitis in children: A systematic review and meta-analysis. J Pediatr Surg. 2022;57(3);394-405.

Liu Y, Cui Z, Zhang R. Laparoscopic versus open appendectomy for diagnosed acute appendicitis in children. Indian Pediatr. 2017;54(11):938-41.

Low ZX, Bonney GK, So JB, Loh DL, Ng JJ. Laparoscopic versus open appendectomy in pediatric patients with CA: A metaanalysis. Surg Endosc. 2019;33(12):4066-77.

Li P, Han Y, Yang Y, Guo H, Hao F, Tang Y, et al. Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients: Laparoscopic versus open surgery for appendiceal abscess. Medicine (Baltimore). 2017;96(30):e7514.

Milewczyk M, Michalik M, Ciesielski M. A prospective, randomized, Unicenter study comparing laparoscopic and open treatments of acute appendicitis. Surg Endosc. 2003;17(7):1023-8.

Wang X, Zhang W, Yang X, Shao J, Zhou X, Yuan J. Complicated appendicitis in children: is laparoscopic appendectomy appropriate? A comparative study with the open appendectomy-our experience. J Pediatr Surg. 2009;44(10):1924–7.

Lee SL, Yaghaoubian A, Kaji A. Laparoscopic vs open appendectomy in children: out-comes comparison based on age, sex, and perforation status. Arch Surg. 2011;146(10):1118–21.

Tan WJH, Pek W, Kabir T, Chan WH, Wong WK, Ong HS. Clinical outcome and cost comparison between laparoscopic and open appendicectomy. Ann Acad Med Singapore. 2014;43(9):464-8.

Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, et al. Laparoscopic versus open appendectomy for acute appendicitis: a meta-analysis. Surg Endosc. 2011;25(4):1199-208.

Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, et al.Laparoscopic versus conventional appendectomy – a metaanalysis of randomized controlled trials. BMC Gastroenterol. 2010;10(1):1-8.

Cipe G, Idiz O, Hasbahceci M, Bozkurt S, Kadioglu H, Coskun H, et al. Laparoscopic versus open appendectomy: Where are we now? Chirurgia (Bucur). 2014;109(4):518-22.

Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, et al. Surgical site infection after laparoscopic and open appendectomy: A multicenter large consecutive cohort study. Surg Endosc. 2015;29(6):1384-93.

Jen HC, Shew SB. Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis. J Surg Res. 2010;161(1):13-7.

Brügger L, Rosella L, Candinas D, Güller U. Improving outcomes after laparoscopic appendectomy: a population-based, 12-year trend analysis of 7446 patients. Ann Surg. 2011;253(2):309-13.

Bence CM, Wu R, Somers KK, Szabo A, Arca MJ, Calkins CM, et al. A tiered approach to optimize pediatric laparoscopic appendectomy outcomes. J Pediatr Surg. 2019;54(12):2539-2545.

Gosemann JH, Lange A, Zeidler J. Appendectomy in the pediatric population-a German nationwide cohort analysis. Langenbecks Arch Surg. 2016;401(5):651-659.

Schäfer M, Krähenbühl L, Frei E, Büchler MW. Laparoscopic appendectomy in Switzerland: a prospective audit of 2,179 cases. Dig Surg. 2000;17(5):497-502.

Keser Şahin HH, Baş Y, Şenel E. Analysis of cytokine and COVID-19 associated cytokine storm researches in scientific literature: A bibliometric study. The Injector. 2022;1(1): 2-15.

Baber A. The effect of the COVID-19 pandemic on the psychological state of healthcare workers around the world: a review. The Injector. 2022;1(1):16-30.

Zumrad Р, Ergasheva Z. Morphologıcal manifestations of myocardial lesion in Covid-19. IJSP. 2022;1(1):46-52.

Hubaybah H, Siregar SA, Putri FE, Fitri A, Rahayu FS. Factors related to anxiety level of public health employees during COVID-19. Janh. 2022;4(1):23-32.

Wibowo DA. Self efficacy of the elderly after the COVID 19 vaccine. Janh 2022;4(1):118-25.

Fuadah DZ, Siswoaribowo A. Online learning methods with stress of parents with children ages 7-9 years in the COVID-19 pandemic season. Janh 2022;4(1):110-7.

Musslifah AR. Optimization of islamic counseling and understanding of well being in reducing anxiety and stress in face-to-face learning after the COVID-19 Pandemic. Janh 2022;4(1):103-9.

Coşar Y, Yavuz S. Congenital chloride diarrhea as a cause of congenital diarrhea: A case report. The Injector. 2022;1(1):40-3.

Demir AM, Aydın C, Hıdımoğlu B, Dereci S, Kanık Yüksek S, Karakuş E. CMV colitis in children: Single-center experience: CMV colitis in children. The Injector. 2022;1(2):70-9.

Agrawal A, Viswanathan V, Sandlas G, Agrawal A. Analyzing the Outcomes of Laparoscopic Appendectomies in Children: Lessons Learned from 153 Consecutive Surgeries. World. 2022;15(2):124.

Zeytun H, Okur MH, Basuguy E, Arslan S, Aydogdu B, Turkcu G, et al. Congenital-infantile fibrosarcoma of the ileocecal region: the first case presentation. Pediatr Surg Int. 2016;32(1):97-99.

Basuguy E, Okur MH, Zeytun H, Arslan S, Aydogdu B, Otcu S, et al. Management of symptomatic urachal cysts in children. Niger J Clin Pract 2019;22(1):113–116.

Güzel M, Arslan S, Turan C, Doğanay S. Management of renal injury in children. Ann Ital Chir. 2015;86(3):246-251.

Klyuev SA, Asharur RM, Goremykin IV, Masevkin VG, Shintaev TK, Azizoğlu M. Two types of gastric volvulus in children: Case reports and review of the literature. J Clin Tri Exp Invest. 2022;1(1):10-6.

Arslan S, Basuguy E, Zeytun H, Okur MH, Aydogdu B, Arslan MS. Jejunoileal perforation and volvulus caused by multiple magnet ingestion. Acta Clin Croat. 2015;54(1):96-8.

Ali R, Khan MR, Pishori T, Tayeb M. Laparoscopic appendectomy for acute appendicitis: Is this a feasible option for developing countries? Saudi J Gastroenterol. 2010;16(1):25.

Shaikh AR, Sangrasi AK, Shaikh GA. Clinical outcomes of laparoscopic versus open appendectomy. JSLS. 2009;13(4):574.

Ingram MC, Calabro K, Polites S, McCracken C, Aspelund G, Rich BS, et al. A systematic review of disparities in care and outcomes in pediatric appendectomy. J Surg Res. 2020;249(5):42-9.

Arslan S, Okur M, Basuguy E, Aydoğdu B, Karaduman E, Azizoğlu M, et al. Analysis of mortality risk factors for newborns with Bochdalek diaphragmatic hernia – a 10-year single-centre experience. SAJS. 2022;60(3):24-31.

Arslan S, Aydogdu B, Arslan MS, Zeytun H, Okur MH, Basuguy E, et al. Analysis of Risk Factors for Appendicitis in Children: A Multicenter Epidemiological Study. Dicle Med J. 2016;43(4):556-560.