Acceptable outcome after laparoscopic appendectomy in children

Abstract

Introduction: An increasing proportion of childhood -appendicitis is being treated with laparoscopic appendectomy (LA). We wanted to elucidate the outcome of childhood appendicitis treated primarily by residents in a university hospital.

Material and methods: All children (age<16 years) with appendectomy treated surgically in our department between January 2006 and January 2011 were identified retrospectively. Readmission, reoperation or post-operative length of hospital stay (LOS) exceeding five days were considered non-satisfactory outcomes.

Results: A total of 390 children had an appendectomy performed. The mean age was 9.8 years, and mortality was 0.0%. The surgeon was a resident in 92% of the cases. A total of 246 (63.1%) had an LA. The rate of LA increased over the five-year period from 45% to 88% (p=0.01). The conversion rate decreased from 28% to 15% (p=0.02). The median post-operative LOS was one and three days for simple and complicated appendicitis, respectively. A total of 45 patients (11.5%) had a complication, 40 patients (10.3%) were readmitted, and 56 patients (14.4%) had a non-satisfactory outcome. Logistic regression found open surgery and complicated appendicitis to be associated with an increased risk of complications (p<0.01).

Conclusion: Increased use of LA did not increase the number of patients with a non-satisfactory outcome. Residents manage this treatment at a highly professional level. Readmission due to pain and discomfort was frequent and more targeted and systematic post-operative analgesic care of our children is called for.

Funding: Not relevant.

Trial registration: The study was submitted to ClinicalTrials.gov (NCT01657565).