Système gastro-intestinal et digestif

Abstrait

Laparoscopic Appendectomy in Children: A Comparative Analysis of Single Port Intra-Corporeal Technique with Standard 3-Port Approach

Umashankar K. Ballehaninna and Sathyaprasad C Burjonrappa

Purpose: Single port appendectomy (SPA) offers a new paradigm to minimally invasive approach for appendectomy in children. This study sought to evaluate feasibility and assess its’ clinical effectiveness compared to traditional 3-port approach (3PA).

Methods: After an institutional review board approval, data from children with acute appendicitis, admitted to a single surgeon, who underwent SPA were prospectively collected and compared with 3 PA (2010-2012). Outcomes analyzed include operative duration, blood loss, time to resume diet, duration of hospital stay, cumulative dose of antibiotics and analgesics as well as comparison of complication rate and types.

Results: 104 children underwent either SPA (N=52) or 3PA (N=52). Both groups were age and sex-matched and there was no statistical difference with regards to clinical presentation, leukocyte count, severity of illness, mode of diagnosis (Ultrasound or computerized tomography scan), preoperative antibiotic usage and time from admission to actual time of operation (p>0.05). Average operative time for SPA was 66.5 min compared to 56.6 min using 3PA (p<0.05). The SPA group had an increased length of hospital stay; total dose of analgesics and complications (wound infection, abscess-requiring drainage, ileus and readmission), albeit not statistically significant. There were no significant difference pertaining to intra-operative blood loss, duration of antibiotic therapy, pathologic subtypes and antibiotic prescription among either groups.

Conclusions: This study illustrates that while SPA is technically feasible in the pediatric population it may be associated with a higher incidence of surgical morbidity. Larger randomized controlled studies are needed to verify its applicability in pediatric appendicitis.