Demographics, complications and outcomes of laparoscopic appendectomy in paediatric patients: A 15-year study from western India.

Introduction: Acute appendicitis is one of the most common causes of abdominal pain in children and is considered the most frequent paediatric surgical emergency. The incidence progresses from extremely low in the neonatal period to a peak incidence between ages 12 and 18 years. Prompt diagnosis and management are imperative to prevent serious complications such as perforation, peritonitis, intra-abdominal abscess formation and bowel obstruction. Laparoscopy has improved intra- and post-operative outcomes for children with appendicitis. This study was conducted to evaluate demographics and complications of laparoscopic appendicectomy in Indian children.

Patients and methods: This is a retrospective cohort study encompassing 714 consecutive patients of appendicitis operated over 15 years (2006-2021) by a single surgeon at a high-volume private paediatric surgical centre in Western India. Data collected included age and gender, duration of surgery and post-operative variables such as length of stay and early or delayed interventions, if any. The patients were categorised into two groups: complicated appendicitis and non-complicated appendicitis, depending on the operative findings. Patients with acutely inflamed appendix without perforation, peritonitis or collection and patients with chronically inflamed appendix were categorised as non-complicated appendicitis. Patients with perforated or gangrenous appendicitis, appendicular lump and appendicitis with intraperitoneal collection were categorised as complicated appendicitis. Additional pathologies found and treated during the surgery were also documented. The statistical analysis was performed using IBM SPSS Statistics 28.0.0.0.

Results: The total cohort of patients who underwent laparoscopic appendectomy in the study was 714. The number of male patients was significantly greater than the female population (P < 0.001). The total number of cases of non-complicated appendicitis was 580 (81.23%). Patients with uncomplicated appendicitis had a mean age of 9.12 ± 3.65 years, while those with complicated appendicitis had a mean age of 7.49 ± 3.58 years. Additional pathologies such as simple ovarian cyst, Meckel's diverticulum and Enterobius vermicularis were found in 11.55% of uncomplicated cases. Post-operative complications were observed to be higher in the complicated group (27.6%) compared to the uncomplicated group (1.72%).

Conclusion: This study shows that acute appendicitis affects our study population at a mean age of 8.84 years, with a majority of males (64.14%). It also shows that complicated appendicitis has a higher incidence of post-operative complications of 27.6% and prolonged hospital stay. A multicentre research across various states in India can help establish a clear outlook regarding the demographics of complicated and uncomplicated paediatric appendicitis in the country.