Single-blind randomized clinical trial of laparoscopic versus open appendicectomy in children

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Abstract
Background: Appendicectomy is the most common emergency surgical operation in children. The aim of this study was to compare recovery after appendicectomy using either a laparoscopic or an open technique in children. Methods: Sixty-one children aged 4–15 years undergoing appendicectomy for suspected uncomplicated appendicitis were studied. The study was prospective, randomized and single-blinded, with parallel groups. Standardized anaesthetic technique and pain management were used. The study endpoints were postoperative pain, need for rescue analgesia, and length of hospital stay. Results: Children had significantly less pain after laparoscopic compared with open appendicectomy 8 h after operation and on the first and second postoperative mornings (P < 0·05). Laparoscopic appendicectomy resulted in a reduced requirement for rescue analgesia with oxycodone in hospital: mean(s.d.) 3·6(2·5) versus 5·8(3·3) doses (mean difference 2·2 doses, 95 per cent confidence interval (c.i.) 0·6–3·8 doses); P = 0·01. The mean(s.d.) length of hospital stay was significantly shorter in the laparoscopic group: 1·9(0·7) versus 2·6(0·9) days (mean difference 0·7 days, 95 per cent c.i. 0·3–1·1 days); P = 0·001. Three children who had open appendicectomy developed a wound infection. Conclusion: Laparoscopic appendicectomy is associated with less postoperative pain and a shorter hospital stay than open appendicectomy in children undergoing surgery for uncomplicated appendicitis.