Current status of laparoscopic appendectomy in children.

Appendectomy is the most common surgical emergency in children. Laparoscopic appendectomy (LA), first performed by Semm in 1983, has increased in popularity for both uncomplicated and ruptured appendicitis. The authors perform early laparoscopic appendectomy for acute uncomplicated appendicitis, but use aggressive antibiotic therapy for obvious ruptured appendicitis. Patients presenting with accessible abscesses have drainage using image guidance. Antibiotic therapy is continued at home until the fever has resolved and the white blood cell and differential counts have normalized. An interval appendectomy is performed 2 to 3 months later. Children with ruptured appendicitis for whom aggressive medical management had failed usually had a persistent pattern of small bowel obstruction noted 72 hours after initiation of treatment. The authors' preferred technique for laparoscopic appendectomy employs linear stapling of the mesoappendix and appendix. LA patients had a shorter hospital stay and a lower wound infection rate. The operating times for open and laparoscopic appendectomy were similar.