Laparoscopic versus open appendectomy in children--comparative study of 403 cases.

Laparoscopic appendectomy (LA) has not achieved widespread acceptance among surgeons, open appendectomy (OA) being a simple and secure technique. We compared retrospectively 200 LAs and 203 OAs in children and adolescents (mean age = 10 years) from January 1, 1989, to March 31, 1993. The introduction of LA did not modify our operative indications. Laparoscopic investigations found 22 right lower quadrant peritoneal adhesion diseases (11%), those lesions were totally unknown with OA. Operative complications are more frequent with LA (5% versus 1%--p < 0.02): bleeding of the appendiculary artery or of an epigastric vessel, intestinal perforation and burn of the ileum are the most serious complications that we had. On the other hand, the postoperative complications mostly occur after OAs (10.8% versus 1.5%--p < 0.001): 11 wound abscesses, 8 intraperitoneal infections and 4 obstructions after OA and only 1 wound abscess and 2 intra peritoneal abscesses after LA. The general anesthesia was significantly longer for LA (72 minutes vs 55 minutes--p < 0.001). Mean hospital stay was 4 days after LA and 6.4 days after OA. The postoperative complications involved 27 additional hospital days after LA and 162 days for OA. As a conclusion, OA is quicker and has few operative complications. But LA has many advantages: less traumatic, easy treatment of ectopic appendix, efficient lavage of the peritoneum, less frequent postoperative complications and better postoperative comfort. All this encourages us to go on with LA, all the more as the operative complications fall off with the training of the operator.