Comparison of Classical Open Appendectomy, Small Incision Appendectomy and Laparoscopic Appendectomy in Children with Uncomplicated Acute Appendicitis

Background: The surgical anatomy of appendix coupled with a lax abdominal wall in children creates a possibility of accomplishing an appendectomy using a small incision. The aim of the present study was to compare the outcomes of classical grid iron, small incision and laparoscopic appendectomy in children with uncomplicated acute appendicitis. Method: A prospective comparative study was undertaken at a tertiary care hospital, where patients who underwent either open (classical or small incision) or laparoscopic appendicectomy were studied and compared for various intraoperative and postoperative parameters. The subjects selected for study were children in the age group of 4 – 14 years of age, and were diagnosed as having simple acute appendicitis. Results: Out of a total of 201 patients included in the study; 78 underwent appendectomy by classical Grid iron incision, 62 by small incision and 67 by a conventional laparoscopic method. The baseline parameters were similar in all the three groups. The mean operative time was significantly lower in small incision group. There was no intra-operative complication noticed in any of the groups. Conversions were significantly higher in the small incision group as compared to classical grid iron and laparoscopic approach. The mean pain scores (visual analogue scale) were significantly decreased in the laparoscopic group. The mean hospital stay and return to activities of daily life was significantly increased in the classical grid iron group. Conclusion: Laparoscopic approach for appendectomy seems to be a clear winner in uncomplicated paediatric appendicitis, but small incision approach provides an acceptable alternative, as compared to the standard grid iron incision.