The Complication Rate and Outcomes of Laparoscopic Appendicectomy in Children with Perforated Appendicitis

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Abstract
Background: In many institutions, laparoscopic appendicectomy (LA) has become the preferred technique for the treatment of uncomplicated acute appendicitis in children, although the role of laparoscopic techniques with advanced appendiceal disease (when the appendix is perforated or has produced an abscess) remains controversial. This study examines the complication rate and outcome in these patients. Method: A retrospective review was conducted of all children with perforated appendicitis undergoing LA at one institution during a five-year period. Complications and key parameters of outcome were analyzed. Results: Laparoscopic appendicectomy was completed in 49 children with perforated appendicitis evident at operation and confirmed on histopathology. Nine children (18%) developed some type of complication: six (12%) developed an intra-abdominal abscess that required drainage; two (4%) required readmission and intravenous antibiotics to treat a phlegmon; and one child (2%) developed a small bowel obstruction that required surgical intervention and adhesiolysis. Preoperative duration of symptoms, operative appearance, and operative time did not affect the rate of complications. Length of antibiotic use and the experience of the surgeon seem to influence the rate of complications. Conclusions: Rates of postoperative phlegmon and intra-abdominal abscess after laparoscopic management of perforated appendicitis in children would appear to be higher than those of open series, although the overall complication rate appears to be declining. Laparoscopic experience may affect the complication rate. The decision to perform a laparoscopic approach on the child with advanced disease and suspected perforated appendicitis should be based on the level of laparoscopic expertise of the surgeon.