In Vivo Measurements of Appendiceal Base - Implications on Pediatric Laparoscopic Appendectomy.

Background and objectives: Securing the base of the appendix is the most critical part of laparoscopic appendectomy in children. Determining the average values of the appendix, will facilitate the creation of suitable instruments, and will also have an impact on research in imaging studies.

Methods: One hundred and eight patients with the acute appendicitis were randomized into 2 groups: group I: children aged 2-10 years old, group II: children >10 years of age. Each group was further divided into 3 subgroups: phlegmonous, gangrenous and perforated forms of acute appendicitis. The external diameter of the appendiceal base, the middle part of the appendix, the tip and the length were determined. The measurements were made with the help of Vernier calipers, and expressed in millimeters.

Results: In group I, the average size of the appendiceal base in the phlegmonous form was 5.68 ± 1.51 mm, in the gangrenous form 7.08 ± 1.82 mm, and in the perforated form 6.94 ± 2.43 mm. In group II, the average size of the appendiceal base in the phlegmonous form was 7.29 ± 2.75 mm, in the gangrenous form 7.24 ± 2.11 mm, and in the perforated form 9.31 ± 3.07 mm.

Conclusion: Although most appendices can be removed by standard methods, the maximum sizes observed in this study reveal that standard endoloop or plastic and titanium clips cannot be used in the procedure and instead the more expensive stapler has to be utilized.