Trends in the Use of Laparoscopic Versus Open Paediatric Appendicectomy: A Regional 12-Year Study and a National Survey
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In adult patients, it is generally accepted that laparoscopic appendicectomy (LA) is the predominant operative pathway in treating acute appendicitis. The case for a similar pathway utilising LA in children is less clear. We investigate usage, trends and complications after LA in children in a single co-located adult/paediatric centre with contemporaneous adults as controls.
A retrospective case–control study was conducted over 12 years including patients who underwent appendicectomy, and the paediatric series (<16 years) was divided into age-groups-based quartiles. An anonymous questionnaire-based national survey was circulated among general and paediatric surgeons.
Of the 5784 appendicectomy patients, 2960 were children. LA rate in paediatric appendicitis was 65%. Yearly trends in LA reached a steady state in both groups after 2010 (Δ 0–1%/year). Rates of LA and LA IAA (respectively) differed significantly between age groups: 60, 3% (0–9 years); 65, 1% (10–13 years); 71, 2% (14–16 years) and 93, 3% (>16 years) (p = 0.001, 0.02). The national survey showed respondents believed LA was not superior to OA in paediatric patients except in terms of cosmesis. There was strong support in the use of LA in older children and children >40 kg.
The use of LA in paediatric appendicectomies in the study region is similar to international rates, but not increasing over time. Irish surgeons still favour OA in younger children and prefer a case-by-case approach rather LA being the preferred pathway. This is despite the regional and international evidence showing favourable outcomes with LA in children.
- 3.Neugebauer E, Troidl H, Kum CK, Eypasch E, Miserez M, Paul A (1995) The E.A.E.S. consensus development conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements–September 1994. The Educational Committee of the European Association for endoscopic surgery. Surg Endosc 9(5):550–563PubMedGoogle Scholar
- 20.Hospital In-Patient Enquiry. https://www.hiqa.ie/healthcare/health-information/data-collections/online-catalogue/hospital-patient-enquiry. Accessed 07 Dec16
- 23.York D, Smith A, von Allmen D, Phillips JD (2006) Laparoscopic appendectomy in children after the learning curve. JSLS J Soc Laparoendosc Surg 10(4):447–452Google Scholar
- 28.Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, Stamos MJ (2012) Comparison of outcomes of laparoscopic versus open appendectomy in children: data from the Nationwide Inpatient Sample (NIS), 2006–2008. World J Surg 36(3):573–578. https://doi.org/10.1007/s00268-011-1417-8 CrossRefPubMedGoogle Scholar
- 29.Guana R, Lonati L, Garofalo S, Tommasoni N, Ferrero L, Cerrina A, Lemini R, Dallan C, Schleef J (2016) Laparoscopic versus open surgery in complicated appendicitis in children less than 5 years old: a six-year single-centre experience. Surg Res Pract 2016:5Google Scholar