Efficacy and safety of retrograde laparoscopic appendectomy in pediatric complicated appendicitis: A 14- year retrospective analysis

Journal of Pediatric Surgery Open Pub Date : 2024-12-19 DOI:10.1016/j.yjpso.2024.100188

Mario Riquelme , Carlos Garcia-Hernandez , Irving Alan Cardenas-Medina , Ana Cantu-Zendejas , Alejandro Cendejas-Higuera

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Abstract

Background

Acute appendicitis is the leading cause of emergency abdominal surgery in children. Complicated cases, particularly those with perforation or gangrene, pose a surgical challenge due to significant inflammation and altered anatomy.

Objective

To evaluate the efficacy and safety of retrograde laparoscopic appendectomy (RLA) as an alternative technique in pediatric patients with complicated acute appendicitis, based on data collected over a 14-year period. This study also examines the surgical technique and potential complications associated with RLA.

Methods

This retrospective, observational, and descriptive case series analyzed 30 cases of complicated acute appendicitis treated with RLA from a total of 415 laparoscopic appendectomies performed over 14 years. The patients' ages ranged from 4 to 18 years. Dissection began at the appendicular base, progressing retrogradely to the tip. Variables analyzed included operative time, hospital stay, postoperative complications, and conversion rates to open surgery.

Results

The study included 19 boys (63 %) and 11 girls (37 %). The average operative time was 75 minutes, and the mean hospital stay was 4 days. There were no conversions to open surgery. Postoperative complications were limited to abscess formation at the port sites in 10 % of cases. No intraoperative complications or residual intra-abdominal abscesses were reported.

Conclusion

Retrograde laparoscopic appendectomy (RLA) is a safe and effective technique for managing complicated acute appendicitis in pediatric patients. It is a reproducible procedure for surgeons with experience in laparoscopic techniques, offering a viable alternative in complex cases.