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PubMed1998

Interval appendectomy for perforated appendicitis in children.

To determine the efficacy, safety, and cost of managing perforated appendicitis with intravenous antibiotics followed by an interval appendectomy, the charts of 87 children with ruptured appendicitis were retrospectively reviewed. These patients were treated with intravenous fluid resuscitation and antibiotics (consisting of clindamycin and ceftazidime) and underwent appendectomy, either on that admission (n = 46) or as a delayed interval procedure (n = 41). Antibiotics in all cases were discontinued either at home or in the hospital after the child was a febrile for 48 hours with normal white and differential blood cell counts, and the two groups were compared. Seven patients (17%) "failed" the interval appendectomy protocol. All but one "failure" was due to the development or persistence for >72 hours of a bowel obstruction. The data are described below as percent or mean +/- 1 standard deviation. [table: see text] We conclude that antibiotics and interval appendectomy is a safe effective alternative for the management of perforated appendicitis. When successful, hospitalization, charges, and morbidity are less with this approach. A persistent bowel obstruction for 72 hours is an indication to proceed with appendectomy on admission.

Adolescent↗
PubMed2006

Role of appendectomy in laparoscopic training.

PURPOSE: This study aimed to evaluate whether laparoscopic appendectomy is suitable for training residents to become proficient in laparoscopic surgery. MATERIALS AND METHODS: A total of 1574 laparoscopic appendectomies were performed at En-Chu-Kong Hospital between January 1998 and December 2003 (788 men and 786 women). These cases were divided into three groups: 543 cases (in 1998-1999) performed by 5 attending surgeons during the learning and trial stage; 536 cases (in 2000-2001) performed by 5 attending surgeons assisted by 2 senior residents with prior experience in open appendectomy; and 495 cases (in 2002-2003) done by these 2 senior residents, supervised by the attending surgeons. Demographic data, intraoperative findings, operative time, conversion rate, frequency of analgesic injection, timing of oral intake, hospital stay, morbidity, and mortality were analyzed. RESULTS: There were no statistically significant differences in the operations performed by attending surgeons (mature stage) vs. senior residents in terms of intraoperative findings, operative time (60.1 +/- 60.4 minutes vs. 56.3 +/- 25.6 minutes), conversion rate (1.12% vs. 0.81%), frequency of analgesic injection (0.57 +/- 1.37 times/stay vs. 0.43 +/- 0.94 times/stay), timing of oral intake (23.7 +/- 30.2 hours vs. 20.8 +/- 27.5 hours), hospital stay (73.9 +/- 61.8 hours vs. 70.3 +/- 51.6 hours), morbidity, or mortality (0% vs. 0.2%). CONCLUSION: Laparoscopic appendectomy can be safely incorporated into the training of surgical residents under the supervision of experienced surgeons. Laparoscopic appendectomy also provides knowledge of the basics of laparoscopic technique before going on to more complex operations.

Analysis of Variance↗
PubMed2006

Interval appendectomy: an old new operation.

A retrospective chart review of 32 patients who underwent laparoscopic interval appendectomy at the Children's Hospital of Eastern Ontario between May 1999 and December 2003 was performed. The age range was 0.5 to 18 years (mean, 11.8 years; median, 11.5 years). The interval time from the acute episode to the laparoscopic interval appendectomy ranged from 1 to 16 weeks (median, 6 weeks). The initial presentations were 11 patients with appendiceal abscess, 9 with appendiceal masses/phlegmons, and 12 patients with an acute but resolving clinical picture with ultrasonographic evidence of appendicitis. There were no wound infections or recurrent intra-abdominal abscesses. The average length of stay was 1.38 days, ranging from same-day discharge (1 patient) to a three-night stay (2 patients). There were no complications related to the laparoscopic technique, confirming reports that laparoscopic interval appendectomy is a technically safe procedure. Pathologic analysis of the appendices demonstrated acute or subacute changes in 14 patients (interval time = 7.9 weeks), chronic changes in 8 (interval time = 8.1 weeks), both acute and chronic changes in 5 (interval time = 8.2 weeks), and no pathologic diagnosis in 6 (interval time = 4.28 weeks). These findings support the need for interval appendectomy, and suggest that laparoscopy is a safe alternative to open appendectomy.

Adolescent↗
PubMed1995

Appendectomy and tonsillectomy in patients with inflammatory bowel disease.

Recent reports of reduced appendectomy rates in patients with ulcerative colitis have not distinguished between primary appendectomy (surgery for appendicitis) and incidental appendectomy (removal of the appendix for other reasons). In the present case control study, we examined the frequency of primary appendectomy in subjects with ulcerative colitis (n = 197) and Crohn's disease (n = 117) compared to a control group of dermatology outpatients (n = 243). A reduced rate of primary appendectomy was found in the ulcerative colitis group (adjusted odds ratio 0.20, 95% confidence intervals 0.070-0.53, p < 0.0005) but not in the Crohn's disease patients (adjusted odds ratio 0.93, 95% confidence intervals 0.39-2.18, p = NS). These data suggest that appendicitis occurs less commonly than would be expected in individuals who develop ulcerative colitis. Environmental or immunoregulatory factors may be responsible. Tonsillectomy rates were also examined in each study group, but no overall differences were found between patients with inflammatory bowel disease and controls.

Adult↗
PubMed1994

Laparoscopic appendectomy, is it worth it?

The recent experience with open appendectomy was compared to our initial experience with laparoscopic appendectomy. Thirty-eight patients had open appendectomy for acute appendicitis. Two major and four minor complications occurred. Concurrently, 39 patients had laparoscopic appendectomy. There was one major and one minor complication. Of the laparoscopic patients, 69% received less than 24 hours of parenteral postoperative analgesia, compared to 44% of the patients in the open group. Fifteen of 39 laparoscopic patients (38%) were discharged within 24 hours of operation versus 3 of 38 (8%) in the open group. Total mean hospital cost for the laparoscopic group, $7,500, was significantly greater than for the open group, $5,700, because of increased laparoscopic equipment charges. Both open and laparoscopic appendectomy procedures were performed with minimal morbidity. The benefits of laparoscopy were earlier hospital discharge and less parenteral analgesic use, but it was significantly more expensive.

Acute Disease↗
PubMed1999

Prevalence of previous appendectomy among patients needing gastrointestinal endoscopy.

BACKGROUND: The appendix may be an immune modulator of the gut, and its absence may lead to an increase in gastrointestinal illnesses. If this is true, we may expect patients needing endoscopy to have a higher prevalence of previous appendectomy. METHODS: We did a case-control study at the University of Oklahoma Hospital for 13 months. Subjects having endoscopic evaluation at the University of Oklahoma Hospital formed the study group. Patients seen at the general medicine clinic of the University of Oklahoma served as controls. We recorded the patient's name, age, sex, race, history of smoking, and history of appendectomy or tonsillectomy. RESULTS: The endoscopy group had 524 patients; 469 patients were in the control group. There were no differences based on race or history of smoking. There was greater prevalence of previous appendectomy in the endoscopy group (33.46% vs. 20.55%). The prevalence of tonsillectomy was 29.28% in the study group vs. 21.61% among the controls. Multiple regression revealed that history of appendectomy and not tonsillectomy was related to the performance of endoscopy. CONCLUSION: History of appendectomy is associated with greater performance of endoscopy.

Analysis of Variance↗
PubMed1998

Current status of laparoscopic appendectomy in children.

Acute appendicitis is the most common surgical emergency in children. Open appendectomy has been the standard treatment for decades, with excellent results. Owing to advances in pediatric laparoscopic instrumentation and increased experience with the technique of laparoscopy, however, many centers are routinely performing laparoscopic appendectomy in children. Most studies show a marginal advantage of laparoscopic appendectomy over open appendectomy with regard to length of hospitalization, postoperative analgesia use, length of time until return to full activity, and wound infection rate. There is a wide range of clinical presentation in children with acute appendicitis, from mild inflammation of the appendix to ruptured appendicitis with diffuse peritonitis or localized abscess formation. Patients with ruptured appendicitis have many more complications regardless of the surgical approach. Prospective, randomized studies specifically in children are needed to answer remaining questions regarding any potential benefit of laparoscopic appendectomy and for which patients this technique is best suited.

Appendectomy↗
PubMed2002

Role of appendicitis and appendectomy in the pathogenesis of ulcerative colitis: a critical review.

Besides a genetic predisposition, a causal role of various environmental factors has been considered in the etiology of ulcerative colitis (UC). The association between appendectomy and UC has recently been the subject of intense scrutiny in the hope that it may lead to the identification of important pathogenetic mechanisms. Published data from animal models of colitis demonstrated reduction in experimental colitis after appendectomy, especially if performed at an early age. Several epidemiological case control and cohort studies have shown a strong and consistent relationship. The metaanalysis of 17 case-controlled studies showed an overall odds ratio 0.312 (95% confidence intervals = 0.261-0.373) in favor of appendectomy (p < 0.0001). One of the two recent large cohort studies is in agreement with these results, but the other failed to confirm them. All these studies have suggested that alterations in mucosal immune responses leading to appendicitis or resulting from appendectomy may negatively affect the pathogenetic mechanisms of UC. Further investigation of the role of appendectomy in UC is expected to open new fields for basic scientific research and may lead to the improvement of our understanding for the disease pathogenesis.

Adult↗
PubMed2006

Microscopic colitis is not associated with cholecystectomy or appendectomy.

BACKGROUND: Microscopic colitis is a common cause of chronic watery diarrhea of unknown origin. Some patients develop diarrhea after cholecystectomy, and some patients with microscopic colitis have evidence of bile acid malabsorption. However, the association between cholecystectomy and microscopic colitis has not been studied. A protective effect of appendectomy on the development of ulcerative colitis also has been reported, but its relationship with microscopic colitis has not been studied. The aim of this study was to assess cholecystectomy and appendectomy as potential risk factors for the development of microscopic colitis in a nested case-control study. MATERIALS AND METHODS: Using the Rochester Epidemiology Project, we identified all Olmsted County (Minnesota) residents with an initial diagnosis of microscopic colitis between January 1, 1985, and December 31, 2001. Rates of antecedent cholecystectomy or appendectomy in patients with microscopic colitis were compared with age-, gender-, and calendar year-matched community controls through conditional logistic regression. RESULTS: Microscopic colitis was identified in 130 cases. Cholecystectomy preceded the diagnosis of microscopic colitis in 12 cases (9%) compared with 17 (13%) in the control group (odds ratio [OR] 0.7; 95% CI 0.3-1.5). Appendectomy preceded the diagnosis of microscopic colitis in 39 subjects (30%) compared with 28 (22%) in the control group (OR 1.6; 95% CI 0.9-2.7). Similar results were obtained when the analysis was restricted to microscopic colitis subtype (lymphocytic colitis or collagenous colitis). CONCLUSIONS: In this population-based nested case-control study, no significant association was seen between cholecystectomy or appendectomy and the development of microscopic colitis or its subtypes.

Adult↗
PubMed2001

Needlescopic, laparoscopic, and open appendectomy: a comparative study.

SUMMARY: The benefits of laparoscopic appendectomy appear to be controversial. Since 1994, several abdominal procedures have been completed by using the needlescopic technique, but there appear to be no prospective studies to demonstrate the perceived benefits of needlescopic appendectomy. The authors compared open, laparoscopic, and needlescopic appendectomy in a randomized fashion with regard to duration of surgery, length of hospitalization, analgesic dosage, and surgery-associated complications. From March to July 1998, 75 patients admitted at the emergency station of the authors' hospital with a final diagnosis of acute appendicitis without tumor formation were randomized to receive one of the three treatment categories: open (OA), laparoscopic (LA), and needlescopic (nLA) appendectomy. Laparoscopic and needlescopic appendectomy were performed by using a three-port technique, although the size of the trocar used varied. There were 26 patients in the OA group, 23 in the LA group, and 26 in the nLA group. The mean operation durations for the OA, LA, and nLA groups were 55.4 +/- 28.0 minutes, 69.1 +/- 48.8 minutes, and 62.3 +/- 26.3 minutes, respectively, and these were not significantly different from one another. The mean number of the analgesic doses (Pethidine 1 mg/kg) required was 1.3 +/- 1.2 mg/kg, 0.5 +/- 0.8 mg/kg, and 0.2 +/- 0.6 mg/kg, respectively. Significant differences were noted when comparing the OA with the LA or nLA groups (OA vs. LA, P = 0.02; OA vs. nLA, P = 0.0002; LA vs. nLA, P = 0.06). The mean oral intake durations were 32.2 +/- 16.9 hours, 21.0 +/- 14.6 hours, and 20.8 +/- 16.4 hours, respectively, after surgery for the OA, LA, and nLA groups, and the between-group differences were statistically significant for the OA versus LA group ( P = 0.004) and for the OA versus nLA group ( P = 0.003). The mean durations of hospitalization for the OA, LA, and nLA groups were 3.6 +/-1.8 days, 2.8 +/- 1.4 days, and 2.4 +/- 0.9 days, and difference was detected between the OA and the nLA groups ( P = 0.02). The OA group rendered a greater wound-complication rate and ileus than did the other two groups, but the differences were not detected between the three categories ( P = 0.065, 0.6935). The result of the current study confirmed that the nLA procedure is a feasible and safe one. The nLA procedure provided substantial advantages over the OA procedure in the contexts of diminished postoperative pain and shorter hospital stay without significant increases in postoperative complication rate or surgical time.

Abdominal Pain↗
PubMed2005

Laparoscopic versus open appendectomy: a prospective randomized double-blind study.

SUMMARY BACKGROUND DATA: The value of laparoscopy in appendicitis is not established. Studies suffer from multiple limitations. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a prospective randomized double blind study. METHODS: Two hundred forty-seven patients were analyzed following either laparoscopic or open appendectomy. A standardized wound dressing was applied blinding both patients and independent data collectors. Surgical technique was standardized among 4 surgeons. The main outcome measures were postoperative complications. Secondary outcome measures included evaluation of pain and activity scores at base line preoperatively and on every postoperative day, as well as resumption of diet and length of stay. Activity scores and quality of life were assessed on short-term follow-up. RESULTS: There was no mortality. The overall complication rate was similar in both groups (18.5% versus 17% in the laparoscopic and open groups respectively), but some early complications in the laparoscopic group required a reoperation. Operating time was significantly longer in the laparoscopic group (80 minutes versus 60 minutes; P = 0.000) while there was no difference in the pain scores and medications, resumption of diet, length of stay, or activity scores. At 2 weeks, there was no difference in the activity or pain scores, but physical health and general scores on the short-form 36 (SF36) quality of life assessment forms were significantly better in the laparoscopic group. Appendectomy for acute or complicated (perforated and gangrenous) appendicitis had similar complication rates, regardless of the technique (P = 0.181). CONCLUSIONS: Unlike other minimally invasive procedures, laparoscopic appendectomy did not offer a significant advantage over open appendectomy in all studied parameters except quality of life scores at 2 weeks. It also took longer to perform. The choice of the procedure should be based on surgeon or patient preference.

Adolescent↗
PubMed2006

Laparoscopic versus open appendectomy in children: a meta-analysis.

OBJECTIVE: This study aims to use meta-analysis to compare laparoscopic and open appendectomy in a pediatric population. SUMMARY BACKGROUND DATA: Meta-analysis is a statistical tool that can be used to evaluate the literature in both qualitative and quantitative ways, accounting for variations in characteristics that can influence overall estimate of outcomes of interest. Meta-analysis of laparoscopic versus open appendectomy in a pediatric population has not previously been performed. METHODS: Comparative studies published between 1992 and 2004 of laparoscopic versus open appendectomy in children were included. Endpoints were postoperative pyrexia, ileus, wound infection, intra-abdominal abscess formation, operative time, and postoperative hospital stay. RESULTS: Twenty-three studies including 6477 children (43% laparoscopic, 57% open) were included. Wound infection was significantly reduced with laparoscopic versus open appendectomy (1.5% versus 5%; odds ratio [OR] = 0.45, 95% confidence interval [CI], 0.27-0.75), as was ileus (1.3% versus 2.8%; OR = 0.5, 95% CI, 0.29-0.86). Intra-abdominal abscess formation was more common following laparoscopic surgery, although this was not statistically significant. Subgroup analysis of randomized trials did not reveal significant difference between the 2 techniques in any of the 4 complications. Operative time was not significantly longer in the laparoscopic group, and postoperative stay was significantly shorter (weighted mean difference, -0.48; 95% CI, -0.65 to -0.31). Sensitivity analysis identified lowest heterogeneity when only randomized studies were considered, followed by prospective, recent, and finally large studies. CONCLUSIONS: The results of this meta-analysis suggest that laparoscopic appendectomy in children reduces complications. However, we also see the need for further high-quality randomized trials comparing the 2 techniques, matched not only for age and sex but also for obesity and severity of appendicitis.

Appendectomy↗
PubMed2005

Laparoscopic versus open appendectomy in West Bengal, India.

OBJECTIVE: Laparoscopic appendectomy, although widely practiced, has not gained universal approval. Laparoscopic appendectomy in India is relatively new, and reports regarding its use are few. The aim of this study was to compare laparoscopic with open appendectomy and ascertain its therapeutic benefit, if any, in the overall management of acute appendicitis. METHODS: The study group consisted of 279 patients suffering from acute appendicitis. One hundred patients underwent laparoscopic appendectomy (LA) and 179 patients underwent open appendectomy (OA). Comparisons were based on median values for length of hospital stay, operating time, postoperative morbidity, duration of convalescence and operative cost. Mann-Whitney statistics (T) were calculated and, because of the large sample size, the normal deviate test (Z) was used. RESULTS: Of the 100 patients who were to receive LA, six patients (6%) had the procedure converted to open surgery. The rate of overall complications (LA 15%vs OA 31.8%; P < 0.001) was significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (3 days after LA vs 5 days after OA; P < 0.0001) than after OA. The operating time was shorter (median values: OA 25 min vs LA 28 min; 0.01 < P < 0.05) in patients undergoing OA compared with LA. CONCLUSION: For LA, hospital stay was significantly shorter, and the one-time operative cost appeared to be marginally the same as open surgery. Furthermore, LA was associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.

Adolescent↗
PubMed2000

Appendectomy and the development of ulcerative colitis: results of a metaanalysis of published case-control studies.

OBJECTIVE: Numerous epidemiological studies have been performed to determine risk factors that might contribute to the development of ulcerative colitis (UC). Recent studies have focused on the role of appendectomy in the disease's pathogenesis. This report aims to review and analyze the degree of evidence from recent published studies. METHODS: Medline and Embase databases were scrutinized for studies published between 1987 and January 1999. Reference lists from published articles, reviews, and abstracts from major gastrointestinal (GI) meetings were also reviewed. All studies specifically designed to evaluate the association between appendectomy and UC were selected. Thirteen studies that satisfied our selection criteria were evaluated by metaanalysis. RESULTS: The 13 case-control studies collectively gathered evidence from 2770 patients with UC and 3352 controls. Combining the results of the individual studies gave an overall odds ratio of 0.307 (95% confidence interval [CI] = 0.249-0.377) in favor of appendectomy (p<0.0001). This suggests that appendectomy gives a 69% reduction in the risk of developing UC (95% CI = 62%-75%). The test for heterogeneity (of all 13 studies) was not significant (chi2 = 16.213, d.f. = 12, p>0.10). The influence of potential confounding factors (mainly smoking) on these results could be excluded. CONCLUSIONS: The review of the literature and the metaanalysis of the selected studies suggest that the inverse association between appendectomy and UC is strong and consistent. Further studies are needed to establish whether a causal relationship exists.

Appendectomy↗
PubMed2002

Imaging for suspected appendicitis: negative appendectomy and perforation rates.

PURPOSE: To determine which patients suspected of having acute appendicitis benefit from preoperative imaging. MATERIALS AND METHODS: The medical records of 462 consecutive patients who underwent appendectomy for clinically suspected acute appendicitis and underwent preoperative evaluation at our institution were retrospectively reviewed. Patients were divided into four groups: women (n = 166), girls (n = 46), men (n = 178), and boys (n = 72). Preoperative computed tomography (CT) or ultrasonography (US), requested by the referring clinician, was performed in 313 of the 462 patients. Unnecessary, or negative, appendectomy and perforation rates were calculated for each group for preoperative evaluation with CT, with US, and with neither CT nor US. In addition, the sensitivity and positive predictive value of CT and US were calculated for diagnosing appendicitis. RESULTS: In women, the negative appendectomy rate was significantly lower for those who underwent preoperative CT (7% [six of 85 patients], P =.005) or US (8% [four of 49 patients], P =.019), as compared with 28% [nine of 32 patients] for those who underwent no preoperative imaging (P >.35 for all groups). The negative appendectomy rates for girls, men, and boys were not significantly affected by preoperative imaging. The sensitivity of CT and US for diagnosing acute appendicitis exceeded 93% and 77%, respectively, in all groups. The positive predictive values for both CT and US were greater than 92% in all groups. CONCLUSION: Women suspected of having appendicitis benefit the most from preoperative CT or US, with a statistically significantly lower negative appendectomy rate than women who undergo no preoperative imaging. Therefore, we propose that preoperative imaging be considered part of the routine evaluation of women suspected of having acute appendicitis.

Acute Disease↗
PubMed2006

Carcinoid tumor of the appendix: a consecutive series from 1237 appendectomies.

AIM: To report the experience of the CHU Sart Tilman, University of Liege, Belgium, in the management of appendiceal carinoid tumor. METHODS: A retrospective review of 1237 appendectomies performed in one single centre from January 2000 to May 2004, was undertaken. Analysis of demographic data, clinical presentation, histopathology, operative reports and outcome was presented. RESULTS: Among the 1237 appendectomies, 5 appendiceal carcinoid tumors were identified (0.4%) in 4 male and 1 female patients, with a mean age of 29.2 years (range: 6-82 years). Acute appendicitis was the clinical presentation for all patients. Four patients underwent open appendectomy and one a laparoscopic procedure. One patient was reoperated to complete the excision of mesoappendix. All tumors were located at the tip of the appendix with a mean diameter of 0.6 cm (range: 0.3-1.0 cm). No adjuvant therapy was performed. All patients were alive and disease-free during a mean follow-up of 33 mo. CONCLUSION: Appendiceal carcinoid tumor most often presents as appendicitis. In most cases, it is found incidentally during appendectomies and its diagnosis is rarely suspected before histological examination. Appendiceal carcinoid tumor can be managed by simple appendectomy and resection of the mesoappendix, if its size is <or=1 cm.

Adolescent↗
PubMed2000

[Laparoscopic appendectomy in pediatric patients: experience of 2300 operations].

The experience of 2300 laparoscopic appendectomies in children aged between 7 days and 14 years is presented. Uncomplicated forms of acute appendicitis were observed in 1611 patients (70.1%). Complicated forms were observed in 689 (29.9%) patients: general peritonitis in 196, local peritonitis--in 334, periappendicular abscess--in 122 and friable infiltrate--in 37 patients. Laparoscopic appendectomy according to F. Götz modified and adapted by us to children's age was used for all variants of the appendix location, including atypical. Optimal surgical approaches for children of early age and children over 3 years were developed. All laparoscopic interventions were completed endosurgically. Only in 15 (0.65%) patients the transition to open surgical operation was carried out on a diagnostic phase of the laparoscopic appendectomy for contraindications (solid infiltration, general peritonitis with multiple abscesses, intestine paresis with need of decompression). On comparative estimation of the laparoscopic and traditional appendectomies the indisputable advantages of the endoscopic technique are proved: more smooth course of the postoperative period, reduction of complications' number, reduction of hospital stay. Laparoscopic appendectomy is the most effective technique for the treatment of acute appendicitis complicated forms. Mean operative time was 65 min (range 42-120 min). Total amount of the postoperative complications in this group decreased almost 3 times. Frequency of such serious intraabdominal complications as acute commissural ileus decreased 3.5 times, infiltrates and abscesses of the abdominal cavity--2 times. Suppuration of the anterior abdominal wall was extremely rare. Mean hospital stay reduced almost 2 times. Intraoperative complications and lethality was not observed.

Adolescent↗
PubMedDate not supplied

Open versus laparoscopic appendectomy in children: a comparison of complications.

Although between 4% and 20% of all appendectomies in adults are performed laparoscopically, this procedure is rarely done in the pediatric age group because of the substantially more difficult technique, the expected risks and suspected higher rate of complications. In a prospective study of 500 consecutive appendectomies, we tried to assess the actual rate of complications of each operative approach. We included 362 conventional and 138 laparoscopic appendectomies, the median age of the patients was 10.8 years. The mortality was 0 in both groups. We observed 89 minor and 11 major complications. All major complications (wound infections needing re-operation under general anesthesia, intra-abdominal abscesses, ileus due to adhesions and a case of renal insufficiency because of glomerulonephritis) occurred in the conventional group (n=11, ie, 3% of 362 open appendectomies). Seventy-two minor complications were seen in the same group (20%). In the laparoscopic group, there were 17 (13%) minor complications and no severe complications. This difference was statistically significant. We conclude that in children laparoscopic appendectomy does not carry a greater risk of intra- or postoperative complications and can therefore safely be established as a standard procedure.

Adolescent↗