The effect of the availability of laparoscopic techniques on the treatment of appendicitis in children.

The use of laparoscopic surgery for acute appendicitis (AA) in children has increased over recent years. The aim of this study was to determine what effect the availability of laparoscopic appendicectomy (LA) has had on children admitted with suspected AA. A retrospective review of children admitted between January 1994 and June 1999 inclusive who underwent appendicectomy for suspected AA was conducted. Data recorded included standard demographic information, surgical approach, histopathology of the appendix, complications, and post-operative length of stay. After LA, children had a shorter post-operative stay, although the technique was used less frequently in advanced disease. The rate of normal histology was higher for LA. Laparoscopic surgery was performed in females in 69% of whom 48% had a normal appendix removed. The duration of surgery was longer for LA (59 vs 40 min). The rate of LA increased to 77% in the first 6 months of 1999. There was a decrease in the proportion of laparoscopic procedures converted to open appendicectomy from 50 to 6% during the period reviewed. The ready availability of laparoscopy and increased confidence in its use has resulted in more children, especially females, with suspected AA undergoing laparoscopy. There was a corresponding higher rate of normal appendix removal in this group, but the overall rate of normal histology has not changed, suggesting that the laparoscopic approach is more likely to be employed where the clinical diagnosis is less certain, particularly in older girls.