CONVERSION OF LAPAROSCOPIC APPENDECTOMY TO OPEN APPENDECTOMY IN CHILDREN REASONS AND CLINICAL OUTCOMES

MJ KHAN; . KARAMATULLAH; I ULLAH; MQ KHAN

doi:10.54112/bcsrj.v2023i1.440

Authors

MJ KHAN Department of Pediatric Surgery MMC Mardan, Pakistan
. KARAMATULLAH Department of Pediatric Medicine, MMC Mardan, Pakistan
I ULLAH Department of Pediatric Medicine, GKMC Mardan, Pakistan
MQ KHAN Department of Pediatric Medicine, MMC Mardan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.440

Keywords:

Appendicitis, Laparoscopic Appendectomy, Open Appendectomy, Pediatric Surgery, Conversion, Clinical Outcomes

Abstract

This study was carried out To assess the impact of this conversion on clinical outcomes to better understand the reasons for pediatric patients' open appendectomy procedures as opposed to laparoscopic ones. This medical research study is retrospective. We conducted a retrospective study of pediatric patients (ages 1 to 18) who had appendicectomies at MMC Mardan's Department of Pediatric Surgery between January 2010 and December 2020. Patient demographics, preoperative presentation, surgical technique (open or laparoscopic), conversion reasons, intraoperative findings, postoperative problems, duration of hospital stay, and follow-up results were all recorded. The statistical analysis included logistic regression analyses, t-tests, and chi-square tests when appropriate. The research included 462 pediatric patients, of whom 268 had a laparoscopic appendectomy, and 194 underwent open appendectomy. In 56 patients (20.9%), laparoscopic Conversion to open appendectomy was necessary. The most frequent causes of Conversion were adhesion-related vision difficulties (33.9%) and complex appendicitis (46.4%). Compared to patients who had a successful laparoscopic operation, those who had laparoscopic-to-open Conversion had a substantially greater risk of postoperative problems (24.1% vs. 8.2%, p < 0.001) and longer hospital admissions (mean 4.7 vs. 2.9 days, p < 0.001). The results of a logistic regression study showed that older age (OR 1.22, 95% CI 1.06-1.41) and complex appendicitis (OR 3.14, 95% CI 1.56-6.33) were independent predictors of Conversion. In children, complex appendicitis and intraoperative complications often need Conversion from laparoscopic to open appendectomy. Extended hospital stays and a greater incidence of postoperative complications are linked to these patients. Optimizing results and reducing the need for Conversion need a surgeon with extensive training and expertise in patient selection.

Downloads

Download data is not yet available.

References

Adachi, T., Okamoto, T., Ono, S., Kanematsu, T., & Kuroki, T. (2011). Technical progress in single-incision laparoscopic cholecystectomy in our initial experience. Minimally Invasive Surgery, 2011.

Bansal, S., Banever, G. T., Karrer, F. M., & Partrick, D. A. (2012). Appendicitis in children less than 5 years old: influence of age on presentation and outcome. The American journal of surgery, 204(6), 1031-1035.

Blakely, M. L., Williams, R., Dassinger, M. S., Eubanks, J. W., Fischer, P., Huang, E. Y., . . . Streck, C. (2011). Early vs interval appendectomy for children with perforated appendicitis. Archives of Surgery, 146(6), 660-665.

Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., . . . Tarasconi, A. (2020). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery, 15, 1-42.

Esposito, C., Calvo, A. I., Castagnetti, M., Alicchio, F., Suarez, C., Giurin, I., & Settimi, A. (2012). Open versus laparoscopic appendectomy in the pediatric population: a literature review and analysis of complications. Journal of Laparoendoscopic & Advanced Surgical Techniques, 22(8), 834-839.

Grehan, K. (2022). A pilot randomised trial on the effect of Gaviscon Advance on laryngopharyngeal reflux symptoms in adults referred to an outpatient Speech and Language Therapy service. Trinity Colleg e Dublin. School of Linguistic Speech & Comm Sci. Discipline of Clin Speech & Language Studies.

Horvath, P., Lange, J., Bachmann, R., Struller, F., Königsrainer, A., & Zdichavsky, M. (2017). Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis. Surgical Endoscopy, 31, 199-205.

Idrees, K., & Bartlett, D. L. (2010). Robotic liver surgery. Surgical Clinics, 90(4), 761-774.

Lander, A. (2012). Appendicitis: A Collection of Essays from Around the World: BoD–Books on Demand.

Lanfranco, A. R., Castellanos, A. E., Desai, J. P., & Meyers, W. C. (2004). Robotic surgery: a current perspective. Annals of Surgery, 239(1), 14.

Maggioni, A. P., Anand, I., Gottlieb, S. O., Latini, R., Tognoni, G., Cohn, J. N., & Investigators, V.-H. (2002). Effects of valsartan on morbidity and mortality in patients with heart failure not receiving angiotensin-converting enzyme inhibitors. Journal of the American College of Cardiology, 40(8), 1414-1421.

Sartelli, M., Viale, P., Catena, F., Ansaloni, L., Moore, E., Malangoni, M., . . . Ivatury, R. (2013). 2013 WSES guidelines for management of intra-abdominal infections. World Journal of Emergency Surgery, 8, 1-29.

Yau, K. K., Siu, W. T., Tang, C. N., Yang, G. P. C., & Li, M. K. W. (2007). Laparoscopic versus open appendectomy for complicated appendicitis. Journal of the American College of Surgeons, 205(1), 60-65.