Laparoscopic appendectomy: An unnecessary and expensive procedure in children?

Little, Danny C.; Custer, Monford D.; May, Brett H; Blalock, Shannon; Cooney, Donald R.

doi:10.1053/jpsu.2002.30841

Cited by 91 publications

(74 citation statements)

References 30 publications

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“…LA did not increase the duration of surgery and it had faster recovery in perforated appendicitis. Horwitz et al and some other investigators reported that the length of stay remained unchanged in patients with CA, when LA was compared to OA (17,18). In contrast, the current study has a significantly decreased length of stay in patients with LA and CA.…”

Section: Discussioncontrasting

confidence: 62%

The Comparison Of The Open And Laparoscopic Appendectomy: Is There Any Outcome Difference Between Non-complicated And Complicated Appendicisit?

Bıçakçı¹,

Tander²,

Günaydın³

et al. 2010

TUTFD

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Section: Discussioncontrasting

confidence: 62%

The Comparison Of The Open And Laparoscopic Appendectomy: Is There Any Outcome Difference Between Non-complicated And Complicated Appendicisit?

Bıçakçı¹,

Tander²,

Günaydın³

et al. 2010

TUTFD

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“…Laparoscopic appendectomy has been reported to have advantages when compared with the open approach, including faster recovery time, less scarring, shorter postoperative hospitalization, and a decreased incidence of small bowel obstruction [11][12][13]. Others have found no benefit for the laparoscopic approach [14]. In our institution, laparoscopy is the current approach for all cases regardless of perforation or abscess.…”

Section: Discussionmentioning

confidence: 76%

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Keckler

Tsao

Sharp

et al. 2008

Journal of Pediatric Surgery

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Objective-Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial.Methods-After institutional review board approval, a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006. Continuous variables are listed with standard deviation.Results-There were 52 patients with a mean age of 9.0 ± 3.9 years and weight of 34.4 ± 18.8 kg. The mean duration of symptoms at presentation was 8.4 ± 7.6 days. Percutaneous aspiration only was performed in 2 patients. The mean volume of fluid on initial aspiration/drain placement was 76.3 ± 81.1 mL. The mean time to appendectomy was 61.9 ± 25.2 days. The laparoscopic approach was used in 49 patients (94.2%), of which one was converted to an open operation. The mean length of hospitalization after interval appendectomy was 1.4 ± 1.4 days. A recurrent abscess developed in 17.3% of the patients. Six patients (11.5%) required another drainage procedure. The mean total charge to the patients was $40,414.02. There were 4 significant drain complications (ileal perforation, colon perforation, bladder perforation, and buttock/thigh necrotizing abscess).The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy.Conclusions-The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach. However, this management poses complication risks and uses considerable resources. Therefore, this strategy should be compared with early operation in a prospective trial.

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“…26 There was no difference in visual analogue scored postoperative pain or in narcotic use between open and LA in three trials where this was reported. [29][30][31] However, Lintula 32 reported that pain was significantly reduced at all points with less need for rescue analgesia in their LA group.…”

Section: Laparoscopic Appendicectomymentioning

confidence: 95%

“…The largest published experience remains that of El Ghoneimi et al 33 from four centres in France reporting 1379 cases with a conversion rate of 0.6% and a 'white' appendicectomy rate of 10%. Overall, most authors suggest shorter hospitalisation 26,31,32 and earlier return to normal activities although some of the controls are historical and some reports exclude the more complicated cases from LA. Average operating times vary from about 70 min in older studies 34 to about 40 min in the more recent.…”

Section: Laparoscopic Appendicectomymentioning

confidence: 99%