APPENDECTOMY IN PEDIATRICS: OPEN OR LAPAROSCOPIC?

Background: Appendicitis takes the first place among all the abdominal emergencies in pediatrics. This is because of its 
frequency and potential gravity. Appendectomy is the most common and most effective abdominal operation. Laparoscopic appendectomy, though emerged more than twenty years back, has not gained a universal acceptance among pediatric surgeons to be an option for treating this problem. 
Patients &Methods: Over a period of two years (September 2002 - August 2004), a total of 67 patients with the diagnosis of acute appendicitis were treated by the corresponding author, either open or laparoscopically. In the open technique, the incision used was located in the skin crease at the Mc Burney’s point, in all but in one case with peritonitis where a midline incision was done. In the laparoscopic group, the laparoscopic “in” technique was the routine where the whole procedure was executed laparoscopically before taking the appendix out. All specimens retrieved were sent for histo-pathological examination as a routine. Cases were studied retrospectively. 
Results: The median age of patients included was 9.2 years (age range: from 4 to 13 years). Thirty cases were treated by the open surgery technique (14 males and 16 females) and 37 cases using the laparoscopic technique (24 males and 13 females). Nine cases among the open group were perforated (30%), whereas 18 cases among the laparoscopic group were perforated (49%). Four cases in the laparoscopic group were converted to open surgery during the procedure (conversion rate=11%). All specimens sent for histo-pathological evaluation came back as inflamed appendix in all, but in four cases (negative appendectomy rate=6%). No difference was noticed between the two groups as regards length of hospital stay (LOS), wound infection rate, and return of bowel habits. Intra-abdominal abscess rate was higher in cases of perforated appendicitis treated with laparoscopy. 
Conclusion: Laparoscopy and conventional surgery should be complementary methods in matters of appendectomy. If any other pathology is present, it could be diagnosed rather easier with laparoscopy. This could be also treated using the same technique. However, awareness of the advantages and disadvantages of both, as well as when to convert to open, are important points to consider.