Laparoscopy or Classic Intervention in the Treatment of Acute Appendicitis in Children? What is the Safest Choice?

Introduction: In the full "laparoscopic era" the first option in the treatment of appendicitis in children should be laparoscopic appendectomy. However, more than 20 years after the first laparoscopic operation on the child, the choice is still difficult. Given that numerous studies have described the advantages and disadvantages of the two techniques, in the end individual experience can change the paradigm.

Method: The study is based on reporting the complications of appendectomies, laparoscopic or classic, performed by the team of surgeons from the Sibiu Pediatric Surgery Clinic during 2015-2019.

Results: 573 appendectomies, 443 classic and 130 laparoscopic were reported.. 428 complications of the classic intervention were reported (305 hemorrhagic, 88 infectious and 35 occlusive) and 115 complications of the laparoscopic intervention (36 hemorrhagic, 55 infectious and 24 occlusive). The duration of hospitalization was 5.64 days after laparoscopy and 5.10 days after the classic intervention.

It is found that the frequency of interventions, both laparoscopic and classical, increases in direct proportion to age, but the data have statistical significance only in the age group 1-3 years (OR = 0.17 [95% CI 0.04-0.72 ], p 0.006), in favor of the classical intervention.

Conclusions: The study data demonstrate the safety of the laparoscopic procedure in terms of the frequency of postoperative complications. Although this is significant, the severity is minimal because the length of hospital stay is similar for both procedures.

Once the individual experience is more convincing, choosing laparoscopic appendectomy as the first option will be easier.