SUR3 Laparoscopic Appendectomy: An unnecessary and expensive procedure in children? (Surgery).

SUR3 LAPAROSCOPIC APPENDECTOMY: AN UNNECESSARY AND EXPENSIVE PROCEDURE IN CHILDREN? Danny C. Little, MD, Monford D. Custer, MD, and Donald R. Cooney, MD. Scott & White Hospital, Temple, Tex.

Laparoscopic appendectomy (LA) has been shown to be a cost effective, safe procedure resulting in shorter length of stay (LOS) and sooner return to activity. The relative merits of LA and open appendectomy (OA) are evaluated in this first prospective randomized trial in children. One hundred twenty-nine children with a diagnosis of appendicitis were included. 88 patients (43 boys and 45 girls), aged 1-16 years agreed to be enrolled and were randomized. Randomization was determined by sealed assignment card. OA utilized a 3-4 cm right lower quadrant muscle splitting incision. All wounds were closed without drains. Antibiotics, when used, consisted of gentamycin, clindamycin, and ampicillin. LA was performed by experienced surgeons utilizing a three-trocar technique with reusable instruments to save expense. 21 children (24%) were perforated. All patients were discharged as soon as they were taking a diet. Statistical comparisons were made by Fischer's exact and Wilcoxon rank-sum tests. There were no difference s in postoperative analgesia, resumption of oral intake, morbidity, LOS, or resumption of activities. LA was associated with increased cost and a statistically significant increased operative time. Laparoscopic appendectomy in children is not associated with the same advantages reported in adults. Although safe and easily performed, it is a more expensive alternative and offers no advantages related to length of stay, morbidity, pain relief, or return to normal activities.