Retrospective analysis of laparoscopic management for pediatric complicated appendicitis with concurrent inguinal hernia at a tertiary center.

Abstract

Background: The concurrent surgical treatment of acute appendicitis and inguinal hernia in pediatric patients, particularly in the presence of severe intra-abdominal infections, remains a topic of debate. The aim of this study was to assess the safety and efficacy of simultaneous laparoscopic surgery for complicated appendicitis combined with inguinal hernia in children.

Methods: A retrospective review was conducted on pediatric patients with complicated appendicitis associated with concurrent inguinal hernia treated between January 2016 to December 2022 at a tertiary care center. Patients were divided into two groups: those who underwent simultaneous hernia repair (simultaneous group) and those who received staged procedures (two-stage group). Demographic data, perioperative findings, and follow-up outcomes were analyzed.

Results: A total of 40 patients were included in this analysis, with 29 patients in the simultaneous group and 11 in the two-stage group. No significant differences were observed between the two groups, except for a higher proportion of bilateral inguinal hernia in the simultaneous group. Operative time was longer in the simultaneous group compared to the two-stage group (specifically for primary appendectomy), though this difference was not statistically significant [84.0 (70.0; 105) vs. 68.0 (57.5; 102) minutes, P=0.32]. The simultaneous group experienced a shorter hospital stay and a reduced duration of postoperative antibiotic use compared to the two-stage group [5.00 (4.00; 6.00) vs. 6.00 (5.00; 9.00) days, P=0.056; 4.00 (3.00; 6.00) vs. 5.00 (4.75; 8.00) days, P=0.04]. Over a follow-up period ranging from 11 to 66 months, postoperative complications were observed in only one patient from the two-stage group, with no recurrence of inguinal hernia in the simultaneous group.

Conclusions: Simultaneous laparoscopic treatment of acute appendicitis and inguinal hernia in pediatric patients appears to be a feasible, safe, and effective approach, even in cases involving complicated appendicitis with significant contamination.