Umbilical One-Trocar Laparoscopic Appendectomy (UOTLA) Versus Open Appendectomy (OA) In Children

Objectives: To compare the outcomes of operation and the values of CRP and WBC in the vein blood between Umbilical One-Trocar Laparoscopic Appendectomy (UOTLA) and Open Appendectomy (OA) in children.Methods: 60 children suffered from acute simple appendicitis we-re selected from September 1, 2006 to September 1, 2007 in Dalian Children's Hospital, and were divided into two groups at random,and each group included 30 children. One group was treated with UOTLA, and the other was treated with OA. The two types of surgical operation were compared with the operating time, the recovery time for peristalsis, length of hospital stay, postoperative complications and the values of CRP and WBC in the vein blood 2 hours before operation, the first day and the third day in the morning after operation.Results:After adjusting for other covariates, UOTLA was associated with shorter operating time (UOTLA:19.50±12.20 min, OA: 29.17±12.25 min, P<0.05), shorter recovery time for peristalsis (11.77±6.05 hours versus 16.70±6.47 hours, P<0.05), and shorter media hospital stay (4.47±0.51 days versus 6.53±0.51 days, P < 0.05). There were no significant postoperative complications both UOTLA and OA. The values of CRP increased before operation (UOTLA: 16.07±9.00 mg/L, OA:14.47±6.22 mg/L), and there was no significant difference between the two groups (P>0.05). The values of CRP of the two groups increased significantly in the first day after operation versus that preoperative (UOTLA: 28.57±11.00mg/L , OA:41.63±16.87 mg/L, P < 0.05), and there was significant difference between the two groups (P<0.05). The values of CRP of the two groups decreased in the third day versus that in the first day after operation (UOTLA: 19.33±8.03 mg/L, OA:26.17±10.09mg/L, P<0.05), and there was significant difference between the two groups (P<0.05). The values of CRP of UOTLA decreased to the level of preoperative (P>0.05), but the values of CRP of OA did not decrease to the level of preoperative (P< 0.05). The values of WBC of the two groups increased before operation(UOTLA(:13.84±5.61)*10~9/L, OA(:14.47±5.43)*10~9/L), and did not significantly increase in the first day after operation versus preoperative (UOTLA:(12.24±4.22)*10~9/L, OA:(13.51±5.12)*10~9/L, P>0.05), but decreased in the third day after operation (UOTLA: (10.33±3.25)*10~9/L, OA:(11.12±3.60)*10~9/L). The value of WBC of the two groups in the third day after operation had significant difference versus that preoperative and the first day after operation(P<0.05). All the value of WBC did not have significant difference between UOTLA and OA (P>0.05).Conclusions: UOTLA in children has significant advantages over OA with operating time, recovery time for peristalsis and length of hospital stay. UOTLA in children had less stress reaction than OA.