Comparison of outcome of open appendectomy and Laparoscopic appendectomy with intracorporeal and extracorporeal technique in children: a single-center experience


  • Marin Pollakan Department of surgery, Uttaradit Hospital



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



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.


Download data is not yet available.


Aarabi S, Sidhwa F, Riehle KJ, Chen Q, et al. Pediatric appendicitis in New England: epidemiology and outcomes. J Pediatr Surg 2011;46(6):1106-14.

Chatbanchai W, Hedley AJ, Ebrahim SB, et al.Acute abdominal pain and appendicitis in northeast Thailand. Pediatr Perinat Epidemiol 1989;3(4):448-59.

Papandria D, Goldstein SD, Rhee D, et al. Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J Surg Res 2013;184(2):723-9.

Dunn JCY, Wester T.Appendicitis. In: Holcomb III GW, Murphy JP, St Peter SD. Ashcraft’s Pediatric Surgery.7th Edition. Newyork: Elsevier Health Sciences 2019.664-78.

Lo HC, Hien WK, Huang CH, et al. Does age affect the outcomes and management of pediatric appendicitis in Taiwan?. Formosan J Surg 2016;49(4):174-7.

Nance ML, Adamson WT, Hedrick HL. Appendicitis in the young child: a continuing diagnostic challenge. Pediatr Emerg Care. 2000;16(3):160-2.

Biondi A, Di Stefano C, Ferrara F, et al. Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg 2016;11(1):44.

Kurtz RJ, Heimann TM. Comparison of open and laparoscopic treatment of acute appendicitis. Am J Surg 2001;182(3):211-4.

Guller U, Hervey S, Purves H, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg 2004;239(1):43-52.

Tiwari MM, Reynoso JF, et al. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 2011;254(6):927-32.

Lin YM, Hsieh CH, Cheng CI, et al. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications. Asian J Surg 2012;35(3):113-6.

Minutolo V, Licciardello A, Di Stefano B, et al. Outcomes and cost analysis of laparoscopic versus open appendectomy for treatment of acute appendicitis: 4-years experience in a district hospital. BMC Surg 2014;14:14.

Agrawal SN, Meshram S, Dhruv K. Study of laparoscopic appendectomy: advantages, disadvantages, and reasons for conversion of laparoscopic to open appendectomy. Int Surg J 2017;4(3):993-7.

Li X, Zhang J, Sang L, et al. Laparoscopic versus conventional appendectomy-a meta-analysis of randomized controlled trials. BMC Gastroenterol 2010;3(10):129.

Svensson JF, Patkova B, Almström M, Eaton S, Wester T. Outcome after introduction of laparoscopic appendectomy in children: A cohort study. J Pediatr Surg. 2016;51(3):449-53.

Grewal H, Sweat J, Vazquez WD. Laparoscopic appendectomy in children can be done as a fast-track or same-day surgery. JSLS 2004;8(2):151-4.

Benedict LA, Sujka J, Sobrino J, et al. Same-Day Discharge for Nonperforated Appendicitis in Children: An Updated Institutional Protocol. J Surg Res 2018;232:346-50.

Ates M, Dirican A, Ince V, et al. Comparison of intracorporeal knot-tying suture (polyglactin) and titanium endoclips in laparoscopic appendiceal stump closure: a prospective randomized study. Surg Laparosc Endosc Percutan Tech 2012;22(3):226-31.

Hong TH, Kim HL, Lee YS, et al. Transumbilical single-port laparoscopic appendectomy (TUSPLA): scarless intracorporeal appendectomy. J Laparoendosc Adv Surg Tech A 2009;19(1):75-8.

Vettoretto N, Mandalà V. Single port laparoscopic appendectomy: are we pursuing real advantages? World J Emerg Surg 2011;6:25.

Perea L, Peranteau WH, Laje P. Transumbilical extracorporeal laparoscopic-assisted appendectomy. J Pediatr Surg 2018;53(2):256-9.

Mohan A, Guerron AD, Karam PA, et al. Laparoscopic Extracorporeal Appendectomy in Overweight and

Obese Children. JSLS 2016;20(2):e2016.00020.

Hsu YJ, Chang PC, Wei CH, Wei FY, Duh YC. Extracorporeal and intracorporeal approaches of single-incision laparoscopic appendectomy in children: is one superior to another? J Pediatr Surg 2017;52(11):1764-8.

El-Beheiry M, Davidson J, Jones S, et al. Outcomes of extracorporeal, transumbilical versus intracorporeal laparoscopic appendectomy for acute uncomplicated appendicitis in children and adolescents: A retrospective observational cohort study. J Pediatr Surg 2019;54(5):1059-62.

Switzer NJ, Gill RS, Karmali S. The evolution of the appendectomy: from open to laparoscopic to single incision. Scientifica 2012:895469.

Gasior AC, St. Peter SD, et al.National trends in approach and outcomes with appendicitis in children. J Pediatr Surg 2012;47(12),2264–7.

Aziz O, Athanasiou T, Tekkis PP, et al. Laparoscopic Versus Open Appendectomy in Children: ameta-analysis. Ann Surg 2006;243(3):17-27.

Esposito C, Borzi P, Valla JS, et al. Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World J Surg 2007;31(4):750-5.

Pogorelic Z, Buljubasic M, Susnjar T, et al. Comparison of Open and Laparoscopic Appendectomy in Children: A 5-year Single Center Experience. Indian Pediatr 2019;56(4):299-303.

Wang X, Zhang W, Yang X, et al. Complicated appendicitis in children: is laparoscopic appendectomy appropriate? A comparative study with the open appendectomy--our experience. J Pediatr Surg 2009;44(10):1924-7.

Esposito C, Calvo AI, Castagnetti M, et al. Open versus laparoscopic appendectomy in the pediatric population: a literature review and analysis of complications. J Laparoendosc Adv Surg Tech A 2012;22(8):834-39.

Yau KK, Siu WT, Tang CN, Yang GP, Li MK. Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg. 2007;205(1):60-65.doi:10.1016/j.jamcollsurg.2007.03.017




How to Cite

Pollakan M. Comparison of outcome of open appendectomy and Laparoscopic appendectomy with intracorporeal and extracorporeal technique in children: a single-center experience. HSCR [Internet]. 2022 Jun. 30 [cited 2023 Dec. 1];37(1):71-82. Available from:



Original Articles (นิพนธ์ต้นฉบับ)