CERRAHİ BİLİMLER / SURGICAL SCIENCES Araştırma Yazısı / Original Article 32Aim: Laparoscopic management of pediatric appendicitis remains controversial. A retrospective chart review was performed to compare laparoscopic versus open approach in the treatment of childhood appendicitis. Patients and Methods: Three hundred thirty seven children who underwent appendectomy with preoperative diagnosis of appendicitis over a 36-month period were included to the study. Primary outcome measures were postoperative wound infection, intra-abdominal abscess formation and intestinal obstruction. Secondary outcome measures were the length of operation, time to oral feeding, analgesic need and hospitalization time. Results: Total number of children in laparoscopy group was 126 (39.8%) whereas this number for open group was 188 (59%). There were 3 (1%) conversions in laparoscopy group. Mean length of operative time for laparoscopic (LA: 52 ±1.34 min), and open appendectomy (OA: 54 ± 1.27min), were similar (p>0.05). Time to full enteral feeding (OA: 24 ±1.1h, LA: 14±0.5h), analgesic usage (OA: 48±5h, LA: 24±5h) and length of hospitalization (OA: 3.9±0.1 day, LA: 2.8±0.1 day) were shorter in laparoscopic group compared to the open procedure (p<0.05). Early postoperative complication rate as wound infection (OA: 2.5%, LA: 0.3%), intra-abdominal abscess formation (OA: 1.3%, LA: 0.3%) were higher in OA group (p<0.05). Adhesive intestinal obstruction in need of re-operation was encountered in 5 (1.6 %) children in OA versus none in LA (p<0.05). Similar results were obtained for simple and complicated appendicitis separately. Conclusions: Laparoscopic appendectomy is at least as safe and effective as open appendectomy in the management of childhood appendicitis. LA does not increase length of operation and offers a faster recovery. Postoperative complication rate is low compared to open approach.
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