Laparoscopic appendectomy decreases risks, hospital stay in children

Findings of a large retrospective cohort study support the use of laparoscopic appendectomy (LA) in children.

Laparoscopic appendectomy has become the preferred method of management of appendicitis, but there is controversy about its benefits over open appendectomy (OA), and it still is not the standard of care for children. Furthermore, its use in patients with perforated appendicitis remains controversial. To compare outcomes of LA and OA in pediatric patients, researchers reviewed discharge data on all patients younger than 18 years who underwent LA or OA for appendicitis between 1998 and 2007 at 12 California hospitals. Of 7,650 children included in the study, 3,551 underwent LA and 4,099 OA.

Use of LA increased in all age groups from 22% to 70% over the study period. Children who received LA were older and less likely to have a perforated appendix than those who had OA. For children with both perforated and nonperforated appendicitis, LA resulted in fewer wound infections compared with OA (perforated, 5.7% vs 9.2%; nonperforated, 1.3% vs 2.7%, respectively). LA patients also had shorter hospital stays.

The differences were seen primarily in children older than 12 years. Morbidity and length of hospitalization were similar with LA and OA in patients younger than 12 years. In patients older than 12 years with nonperforated appendicitis, the wound infection rate was significantly lower for LA than OA (1.1% vs 3.5%, respectively). In older children with perforated appendicitis, the abscess drainage rate was significantly lower (8.0% vs 17.5%) and hospital stays were shorter (mean, 4.8 days vs mean, 5.6 days) for LA compared with OA.

Although cost is a concern with LA, the findings of the present study suggest that the cost of LA may be lower than that of OA because of reduced morbidity and shorter hospital stays.

Lee SL, Yaghoubian A, Kaji A. Laparoscopic vs open appendectomy in children: outcomes comparison based on age, sex, and perforation status. Arch Surg. 2011. doi:10.1001/archsurg.2011.144.