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

Kaynakça

1. Whisker L, Luke D, Hendrickse C, et al. Appendicitis in children: a comparative study between a specialist paediatric centre and a district general hospital. J Pediatr Surg 2009; 44:362-367.
2. Ruffolo C, Fiorot A, Pagura G, et al. Acute appendicitis: What is the gold standard of treatment? World J Gastroenterol 2013;19:8799-8807.
3. Krisher SL, Browne A, Dibbins A, et al. Intraabdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 2001;136:438-441.
4. Pokala N, Sadhasivam S, Kiran RP, et al. Complicated appendicitis is the laparoscopic approach appropriate. A comparative study with the open approach:Outcome in a community hospital setting? Am Surg 2007;73:737–741.
5. Tander B, Pektaş O, Bulut M. The utility of peritoneal drains in children with uncomplicated perforated appendicitis. Pediatr Surg Int 2003;19:548-550.
6. Petrowsky H, Demartines N, Rousson V, et al. Evidence-based
7. value of prophylactic drainage in gastrointestinal surgery: a systematic review and metaanalysis. Ann Surg 2004; 240:1074-1085.
8. Bicakci U, Tander B, Gunaydin M, et al. The Comparison of open and laparoscopic appendectomy: is there any outcome difference between non-complicated and complicated appendicitis? Balkan Med J 2011;28:304-306.

9. Mohamed AA, Mahren KM. Laparoscopic appendectomy in complicated appendicitis: Is it safe? J Minim Access Surg 2013;9:55-58.
10. Ionescu S, Andrei B, Liscsandru E, et al. Laparoscopic treatment for complicated acute appendicitis in children, junior athletes. Chirurgia 2014;109:514-517.
11. Nataraja RM, Teague WJ, Galea J, et al. Comparision of intraabdominal abcess formation after laparoscopic and open appendicectomies in children. J Pediatr Surg 2012;47:317-321.
12. Hussain A, Mahmood H, Nicholls J, et al. Prevention of intra-bdominal abscess following laparoscopic appendicectomy for erforated appendicitis: A prospective study. Int J Surg 2008;6:374-377.
13. Cueto J, D′Allemagne B, Vazquez-Frias JA, et al. Morbidity of laparoscopic surgery for complicated appendicitis: An international study. Surg Endosc 2006;20:717–720.
14. Clark JJ, Johnson SM. Laparoscopic drainage of intraabdominal
15. abscess after appendectomy: an alternative to laparotomy in cases not amenable to percutaneous drainage. J Pediatr Surg 2011;46:1385-1389.