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Archivos de Pediatría del Uruguay

On-line version ISSN 1688-1249

Abstract

KLEINMAN, Jorge; FRAGA, Ariel; BOUZAS, Pablo  and  BERAZATEGUI, Ruver. Laparoscopía y apendicectomía laparoscópica en niños: Experiencia nacional. Arch. Pediatr. Urug. [online]. 2010, vol.81, n.1, pp.5-15. ISSN 1688-1249.

Introduction: acute appendicitis is the most common surgical emergency in children. The diagnostic difficulties determine a percentage of evolved appendicitis or unnecessary appendectomies. The morbidity and the incidence of these events diminishes with laparoscopy. Objective: to present our experience with laparoscopy in children, compared with international papers and laparotomy in our country. Method: we conducted a retrospective study of diagnostic laparoscopy (DL) and laparoscopic appendectomy (LA) in the period 2001-2009. Were considered: age, sex, type of appendicitis, surgical time, conversion, complications, reoperation, hospital stay, antibiotic therapy, and histology. We divided the series into a first period of 50 appendectomies in which there were exclusion criteria, and another 75 in which supervised learning was developed. We compared two periods of the AL series between themselves, and the number of AL with a local number with open appendectomy (AA). The categorical variables of interest were analyzed by Chi square, Fisher test and Student t test, using Epi-info 6. Results: 164 procedures were conducted: 125 AL and 39 LD. The first 50 were done in 60 months, and the following 75 in 40. The 91 were held CHPR AL. The mean age was 10.2 (SD 1.9). Males (59%) and simple appendicitis, which corresponded to 60.8% (76 cases), predominated. The conversion rate in the range was 4.8%, with significant reduction (p=0.03) from the first period (10%) to second (1.3%). There were significant reduction (p=0.002) in surgical time between the first period (average 40, DE 15.8) and second (mean 32', DE 7.7). The rate of surgical wound infection (SWI) in LA was 0.8% (one case) and abdominal infection (AI) was 1.6% (two cases). The AI and SWI in the series of AL was lower compared to the number of AA, with a significant reduction in SWI (p 0.001). In both series predominated the use of ampicillin-sulbactam (AMS), and there was no statistically significant differences in mean age or the percentage of AC. Three cases underwent surgery. Appendectomy was avoided in 39 patients who underwent DL. The number of appendicitis confirmed by histology was 123 cases (99.2%). Conclusions: the results of this series highlight the benefits of the DL and the AL in children. In the AL series a significant decrease in surgical time and the rate of conversion of first and second periods was observed. Compared to the number of AA had a lower proportion of infectious complications; the reduction of the SWI was statistically significant (Chi square 10.7, p 0.001), and the reduction of postoperative infection was also significant (Chi square 8.7, p for 0.003) when comparing the number of AA with the second period LA, during which there were no exclusion criteria

Keywords :  APPENDECTOMY-methods;  LAPAROSCOPY-methods; APPENDICITIS-surgery;  DIAGNOSTIC TECHNIQUES, SURGICAL.

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