Laparoscopic appendectomy for perforated appendicitis in children: Is intraperitoneal drainage necessary?

Abstract

Objective: In this study, our aim is to evaluate the necessity of intraperitoneal drainage in perforated appendicitis.

Methods: 510 pediatric patients [246 laparoscopic (LA) and 264 open (OA)] underwent appendectomy between 2007 and 2014. 275 of them were perforated appendicitis (106 LA, 169 OA). The patients were retrospectively evaluated in terms of age, sex, symptoms, length of hospital stay (LOHS), antibiotherapy, postoperative nasogastric tube placement and intraperitoneal drainage, follow-up period, intraoperative and postoperative complications.

Results: Statistically significant differences were observed between laparoscopic perforated appendicitis (71 male, 35 female; median 9.5 years) and open perforated appendicitis (108 male, 61 female; median 9 years) groups in terms of placement of nasogastric tube (102/106 vs.169/169) (p=0.021), length of hospital stay (1.67± 0.11 days vs. 2.34± 0.09 days) (p<0.001), intraperitoneal drainage (32/106 vs. 138/169), (p<0.001), duration of intraperitoneal drainage (1.66± 0.28 vs. 4.21± 0.2 days) and LOHS (5.82± 0.3 vs. 4.23± 0.6 days) respectively (p <0.001). There was no significant difference between the two groups in terms of development of intra-abdominal abscess (10/106 vs. 9/169), (p=0.144), surgical site infection (2/106 vs. 8/169), (p=0.187) and development of adhesive intestinal obstruction (1/106 vs. 9/169) (p=0.053).

Conclusion: Laparoscopic access reduces the necessity for drainage and shortens duration of nasogastric tube and length of hospital stay. J Clin Exp Invest 2015; 6 (3): 224-227

Key words: Laparoscopic appendectomy, perforated appendicitis, intraperitoneal drainage

Keywords

• Laparoscopic appendectomy, perforated appendicitis, intraperitoneal drainage

Çocuklarda perfore apandisitlerde laparoskopik apendektomi: İntraperitoneal drenaj gerekli midir?

Öz

Amaç: Bu çalışmada amacımız, perfore apandisitlerde intraperitoneal drenajın gerekliliğini değerlendirmektir.Yöntemler: 2007-2014 yılları arasında 510 çocuk hastaya [246 laparoskopik (LA) ve 264 açık (OA] apendektomi yapıldı. Bunların 275’i perfore apandisitti (106 LA, 169 OA). Hastalar, yaş, cins, belirtiler, hastanede kalış süresi, antibiyoterapi, postoperatif nazogastrik tüp ve intraperitoneal dren, takip periyodu, intraoperatif ve postoperatif komplikasyonları açısından retrospektif olarak değerlendirildi.Bulgular: İstatistiksel olarak, laparoskopik perfore apendektomi (71 erkek, 35 kız ve ortanca yaş 9,5) ile açık perfore apendektomi (108 erkek, 61 kız ve ortanca yaş 9) yapılanlar arasında nazogastrik tüp (N/G) takılması (102/106 ve 169/169), (p=0,021), N/G kalış süresi (1,67± 0,11 ve 2,34± 0,09 gün), (p<0,001) , intraperitoneal drenin varlığı (32/106 ve 138/169),(p<0,001) intraperitoneal drenajın süresi (1,66± 0,28 ve, 4,21± 0,2 gün) (p<0,001) ve hastanede kalış süresi (5,82± 0,3 ve 4,23± 0,6 gün), (p<0,001), yönüyle anlamlı farklılıklar gözlendi (p <0,05). İntraabdominal abse (10/106 ve 9/169) (p=0,144) cerrahi alan enfeksiyonu (2/106 ve 8/169) (p=0,187) ve adheziv intestinal obstrüksiyon (1/106 ve 9/169) yönüyle istatistiksel olarak anlamlı fark yoktu (p=0,053). Sonuç: Laparoskopik girişim, drenaj gereksinimini azaltır, N/G tüp ve hastanede kalış süresini kısaltır

Anahtar Kelimeler

• Laparoskopik apendektomi, perfore apandisit, intraperitoneal dren

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