Adhesive small bowel obstruction after appendectomy in children – Laparoscopic versus open approach
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In brief
In brief
This 15-year retrospective study of 619 pediatric appendectomy patients found no significant difference in small bowel obstruction rates between laparoscopic and open approaches. Perforated appendicitis and postoperative abscess—not surgical technique—were the primary risk factors for adhesive obstruction requiring reoperation.
Written by the GCMD Library team from the article.
Abstract
Background
The aims of this study were to compare the incidence of small bowel obstruction (SBO) requiring laparotomy after laparoscopic appendectomy (LA) and open appendectomy (OA) in children and to identify risk factors for SBO.
Methods
Medical records of patients who underwent appendectomy from 2000 to 2014 at our department of Pediatric Surgery were reviewed. Risk factors were analyzed using Cox proportional hazard regression.
Results
Totally 619 out of 840 patients were included. OA was performed in 474 (76.6%), LA in 130 patients (21%), and 15 (2.4%) were converted from LA to OA. Age, sex and proportion of perforated appendicitis were comparable in the LA and OA groups. Median follow-up time was 11.4 years (2.6–18.4). The incidence of SBO after LA was 1.5%, after OA 1.9% and in the converted group 6.7% (p = 0.3650). There were no significant differences in the incidence of postoperative intraabdominal abscess, wound infection or length of stay between LA and OA. Perforation and postoperative intra-abdominal abscess were identified as risk factors with 9.03 (p < 0.001) and 6.98 (p = 0.004) times higher risk of SBO, respectively.
Conclusions
The risk for SBO after appendectomy in children was significantly related to perforated appendicitis and postoperative intra-abdominal abscess and not to the surgical approach.
Level of Evidence
Level III.