Current status of laparoscopic appendectomy in children.

Acute appendicitis is the most common surgical emergency in children. Open appendectomy has been the standard treatment for decades, with excellent results. Owing to advances in pediatric laparoscopic instrumentation and increased experience with the technique of laparoscopy, however, many centers are routinely performing laparoscopic appendectomy in children. Most studies show a marginal advantage of laparoscopic appendectomy over open appendectomy with regard to length of hospitalization, postoperative analgesia use, length of time until return to full activity, and wound infection rate. There is a wide range of clinical presentation in children with acute appendicitis, from mild inflammation of the appendix to ruptured appendicitis with diffuse peritonitis or localized abscess formation. Patients with ruptured appendicitis have many more complications regardless of the surgical approach. Prospective, randomized studies specifically in children are needed to answer remaining questions regarding any potential benefit of laparoscopic appendectomy and for which patients this technique is best suited.