การเปรียบเทียบผลลัพธ์ของการผ่าตัดโรคไส้ติ่งอักเสบ ระหว่างการผ่าตัดแบบเปิดหน้าท้องกับการผ่าตัดแบบผ่านกล้อง ด้วยเทคนิคตัดไส้ติ่งในช่องท้องและนอกช่องท้องในผู้ป่วยเด็ก

Marin Pollakan

doi:10.1016/hscr.v37i1.256353

Authors

Marin Pollakan Department of surgery, Uttaradit Hospital

DOI:

https://doi.org/10.1016/hscr.v37i1.256353

Keywords:

Acute appendicitis in children, open appendectomy, laparoscopic appendectomy, outcomes of appendectomy

Abstract

Objective: This study aims to compare the outcomes in terms of length of hospital stay (LOS), operative time, administration of intravenous opioids, and postoperative complications following laparoscopic appendectomy (LA) versus open appendectomy (OA) in children with acute appendicitis. The addition compares the effectiveness outcomes of the laparoscopic extracorporeal appendectomy (LEA) and laparoscopic intracorporeal appendectomy (LIA) technique.

Method: A non-randomized retrospective cohort study by reviewing medical records of pediatric patients (age < 15 years) with acute appendicitis in Uttaradit hospital who underwent LA and OA from 1 January 2017 through 31 December 2020. The statistical analysis was performed using the Chi-squared T-test and the Mann Whitney U test for comparison.

Results: A total of 263 patients were operated on with acute appendicitis. The LA performed for

158 (60%) cases and OA for 105 (39.92%) cases. The laparoscopic technique used LEA for 114 (72.15%) cases and LIA for 44 (27.84%) cases. The median LOS for LA was better [LA 3 (IQR 2)days versus OA 4 (IQR 4)days, P < 0.01]. The median duration of resumed normal diet for LA was faster [LA 2 (IQR 0.25)days versus OA 2 (IQR 1)days, P-value< 0.001]. The median of intravenous opioids requirements for LA was lower [LA 1 (IQR 2)dose versus OA 2 (IQR 3)doses, P-value < 0.001]. However, the median operative time in LA was longer [LA 40 (IQR 20)min versus OA 30 (IQR 20)min, P-value < 0.004]. The postoperative complications results showed no significant difference between the two groups. In the laparoscopic technique, the median operative time for LEA was shorter than LIA [LEA 35 (IQR 15)min versus LIA 50 (18.75)min, P-value< 0.001].

Conclusion: The LA is a safe and efficient operative procedure for appendectomy in children with appendicitis and it provides advantages over OA (including shorter LOS, earlier resume a normal diet, decreased need for postoperative intravenous opioids). The LEA can reduce operative time. LA should be the initial procedure of choice in children with acute appendicitis.

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