Research On The Application Of Laparoscopy In The Treatment Of Children With Complicated Appendicitis

Part ?:Comparative Study of Laparoscopic Appendectomy Versus Open Surgery in Children With Complicated AppendicitisPurpose:Laparoscopic appendectomy has recently been an alternative procedure for pediatric appendicitis.The aim of the present study was to compare the advantages and disadvantages of laparoscopic appendectomy and open surgery in the treatment of complicated appendicitis in children.Methods:From May 2012 to December 2015,a total of 523 patients underwent treatment for complicated appendicitis in our hospital were involved in the study,including 292 cases with the treatment of laparoscopic operation and 231 caeses with the treatment of open operation.The clinical data in operation time,intraoperative blood loss,incision length,duration of use of antibiotics,duration for resumption of diet,postoperative complications,hospital stay,and hospital charge were compared between the two groups.Results:All patients of the two groups successfully underwent surgery,and there were no perioperative death cases;and there are 2 convertion to open operation in the LA group.There was no significant difference in the operation time between the two groups.There was no significant difference in the intraoperative blood loss between the two groups.The length of operative incision in laparoscopic group was shorter than that of the OA group with statistical significance(P<0.01).The duration for resumption of diet and use of antibiotics was shorter in the LA group than in the open group.14 cases of superficial wound infection was observed in 292 children treated with LA,and 36 cases of wound infection was observed in 231 children treated with OA.There was significant difference in wound infections between the two groups.The incidence of postoperative intra-abdominal abscess or infection in LA group was lower than that in OA group(4/292 in LA versus 11/231 in OA,P<0.05).Children in LA group had less postoperative pain than those in OA group.The hospital stay was also shorter in LA group(7.1±0.4 days versus 8.6±1.2 days,P<0.05).The hospital charge were significantly different between the two groups(P<0.05).Conclusions:Laparoscopic technique is more effective and safer than open appendectomy for complicated appendicitis in children.Part ?:Laparoscopic Transumbilical Single-port Appendectomy:Initial Experience and Comparison With Three-port AppendectomyPurpose:The aim of this study was to compare the feasibility and postoperative outcomes of laparoscopic transumbilical single-port appendectomy with conventional three-port appendectomy in the treatment of complicated appendicitis in children.Methods:From June 2014 to December 2016,75 patients underwent single-port appendectomy(SA).,and 91 patients receiving three-port appendectomy(TA)during the same period.Surgical outcomes such as operation time,intraoperative blood loss,incision length,duration of use of antibiotics,duration for resumption of diet,postoperative complications,hospital stay,and hospital charge were compared between the two groups were analyzed and compared.Results:Comparing SA with TA,there were statistically significant differences in operation time(81.4±15.6 min vs 64.7±11.2 min,P<0.01),complication rate(13.3%vs 2.7%,P<0.01),and hospital total cost(?14834.3±352.5 vs ?13642.1±476.2,P<0.01).The most common complication was wound infection(7 cases for SA and 1 for TA).Two instance of abdominal abscess occurred in patients with perforated appendicitis during SA,and one instance of abdominal abscess occurred in patients with perforated appendicitis during TA.Children in SA group had more postoperative pain than those in TA group.Conclusions:Compared with the traditional laparoscopic surgery,single-port appendectomy has a certain advantage in terms of incision and beauty.But in terms of operation time,infection of incision,postoperative incision pain and hospital expence single-port appendectomy has a certain disadvantage.We believe that the single-port laparoscopy is not dominant,and is not the preferred method of surgery in treating complicated appendicitis in children.Part ?:A Prospective Study of the Feasibility of Early Laparoscopic Appendectomy in Children with Appendiceal MassBackground The management of an appendiceal mass remains controversial with 2 schools of thought;early surgical intervention vs nonoperative management with or without interval appendectomy.The aim is to determine the role and safety of early laparoscopic appendectomy(LA)in children with an appendiceal mass.Methods From January 2013 to December 2016,42 children(AA-LA group)with appendiceal abscess underwent LA immediately after they were diagnosed;46 children(AA-CT group)with appendiceal abscess acted as controls and were treated with conservative therapy and the underwent interval LA 3 to 6 months later;and 92 children(PA-LA group)with perforated appendicitis acted as controls and were treated with LA after they were diagnosed.Surgical outcomes such as operation time,intraoperative blood loss,duration of use of antibiotics,duration for resumption of diet,postoperative complications,hospital stay,and hospital charge were analyzed and compared.Results There were 2 conversions to open appendicectomy in the AA-LA group,and 2 conversions to open appendicectomy in the PA-LA group.Compared with patients in the AA-CT group,patients in the AA-LA group who underwent early LA for an appendiceal mass had a statistically significant longer operating time(63.5±14.2 minutes vs 41.6±8.2 minutes,P<0.01),prolonged time to enterokinesia(42.7±6.5 hours vs 22.6±4.2hours;P<0.01),increased time to resumption of diet(2.8±0.3 days vs 1.8±0.5 days,P<0.01),shortened time for use of antibiotics (6.9±0.6 days vs 14.7±2.3 days,P<0.01),shortend hospital stay(8.1 ± 1.2 days vs 18.7±3.3 days,P<0.01),and reduced hospital charge(?13453.4±976,3 vs?21243.4±1276.3;P<0.01).However,there was no statistical difference in these parameters when LA for an appendiceal mass(AA-LA group)was compared with LA for perforated appendicitis(PA-LA group).Conclusion Although early LA for an appendiceal mass is a technically demanding procedure,it can be performed safely in children.In an era where patients' demand for minimally invasive surgery is rising,early LA is a safe and viable option in the management of children with an appendiceal mass.It also offers the advantage of avoiding misdiagnoses and the need for a second hospitalization.