Comparative Study On Laparoscopic And Open Surgery For The Treatment Of Complex Appendicitis In Children

BackgroundAppendicitis is one of the most common acute abdominal diseases in children.Pediatric acute appendicitis has the characteristics of acute onset,rapid progress,combined with poor language skills in children.Because the symptoms are not typical,clinical diagnosis is difficult.It is often severe when a definite diagnosis maked.Therefore,complex appendicitis in children is common,including gangrene,perforation,and abscess formation.For more than a hundred years,open appendectomy(OA)has been widely used in clinical as a standard surgical procedure for the treatment of appendicitis.It is used for all types of appendicitis.In recent decades,minimally invasive technology has developed rapidly.Laparoscopic appendectomy(LA)has provided more surgical options for the majority of clinicians and children.And the controversy between laparoscopy and laparotomy also arises.ObjectiveBy comparing the efficacy of LA and OA in the treatment of complex appendicitis in children,the clinical significance of LA was explored.MethodSummarized the data of children with acute appendicitis who underwent surgical treatment in our hospital from August 2016 to August 2017,selected children aged 3~14 years,restricted inclusion criteria and exclusion criteria.According to different operative methods,they were divided into LA group(observation group)and OA group(control group).91 cases of children with complex appendicitis was performed,including 42 patients in the LA group and 49 cases in the OA group.Statistical analysis were compared for differences between groups of preoperative and postoperative pain scores,operative time(min),intraoperative blood loss(ml),postoperative bed time(h),postoperative intestinal function recovery(exhaust or defecation)time(h),postoperative complications(incision infection,postoperative intestinal obstruction,residual abscess)occurred.,length of hospital stay(d).Results1.Comparison of preoperative general data: There was no significant difference in the age,sex ratio,history,preoperative white blood cell count and CRP level between the two groups(P>0.05).2.Comparison of intraoperative findings and pathological types: There was no statistically significant difference between the two groups(P>0.05)in abscess formation(abscess around the appendix,abdominal or pelvic abscess),appendicular perforation,and pathological type(pyogenic appendicitis or gangrenous appendicitis).3.Comparison of intraoperative and postoperative general conditions: The LA group had early ambulation,rapid recovery of intestinal function,and short hospital stay than the OA group.The difference was statistically significant(P<0.05).The operative time of OA group was shorter than that of LA group,and the difference was statistically significant(P<0.05).Although the intraoperative blood loss was less in the LA group than in the OA group,the difference was not statistically significant(P>0.05).4.Postoperative complications: LA group was lower than OA group in total postoperative complications,incision infection,postoperative intestinal obstruction,the difference was statistically significant(P<0.05).There was no significant difference between the two groups in abdominal or pelvic residual abscesses(P>0.05).5.Comparison of preoperative and postoperative pain scores: There was no significant difference in preoperative pain scores between the two groups(P>0.05).Compared with OA group,LA group had less pain after operation.The pain scores on the 1st,2nd and 3rd days after operation were statistically significant(P<0.05).ConclusionLA has the characteristics of small surgical trauma,light postoperative pain,rapid recovery,less postoperative complications,and shorter hospital stay.It is a safe and effective treatment in children with complex appendicitis.