SAFETY AND FEASIBILITY OF LAPAROSCOPY IN COMPLICATED APPENDICITIS IN CHILDREN: A TERTIARY CARE HOSPITAL EXPERIENCE FROM KASHMIR

Fayaz Ahmad Najar, Asim Rafiq Laharwal*, Iram Jaan, Syed Shakeeb Arsalaan and Zaffar Saleem Khanday

ABSTRACT

Introduction: Acute appendicitis is the most common surgical emergency in children in any tertiary health care facility. Laparoscopic appendectomy has gained widespread popularity over the past two decades. Laparoscopic appendectomy is an accepted treatment modality in uncomplicated paediatric appendicitis. However, in cases of complicated appendicitis the role of laparoscopic management is not well established. The goal of this study was to demonstrate the safety, efficacy, and potential benefits of laparoscopy in the management of complicated appendicitis in children. Material and Methods: A total of 40 patients were operated on for complicated acute appendicitis and were observed in this study in terms of operative time, hospital stay and post-operative morbidity and mortality. Results: Maximum number of patients belonged to the age group of 4 - 8 years (76%). There was a male preponderance with male: female ratio of 3:1. All the appendectomies were completed laparoscopically. The mean operative time was 58 minutes. Drain was kept in all patients and mean duration of drain removal was 2.5 days. Persistent fever was the main complication and was documented in 2 (5%) of patients, intra-operative bleeding in another 2 (5%) patients, followed by port-site infection and post-operative intra-abdominal abscess in 1 (2.5%) patient each. The mean post-operative length of hospital stay was 3.5 days. No mortality was observed. Conclusion: Laparoscopy is a safe and an effective alternative for appendectomy in children for gangrenous/perforated appendicitis; with a shorter length of hospital stay and acceptable rate of complications. However, close postoperative follow-up and a high index of suspicion for development of complications is recommended.

Keywords: Laparoscopy, Appendectomy, Perforation, Children.