41 Vol. 9. No. 1. June 2003
Laparoscopic Appendectomy in Nonperforated Appendicitis of Children
Dae-Yeon Kim, M.D., Seong-Chul Kim, M.D., In Koo Kim, M.D.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea
Appendicitis is the most common surgical emergency in childhood. Open appendectomy has been the standard treatment. The minimally invasive techniques have been adopted in children after experiences in various surgical conditions in adults has accumulated. lt is
debatable whether laparoscopic appendectomy (LA) is superior to open appendectomy (OA) in children. The goal of this study is to review the results of laparoscopy and laparotomy in the nonperforated appendicitis. The records of 22 patients under 15 years of age who were
operated upon for nonperforated appendicitis at Asan Medical Center were analyzed between December 2002 and April 2003. Age, type and length of intervention, frequency of analgesic use, complication, length of hospitalization, and cost for each treatment groups (N=l1) were
compared. Laparoscopy patients were older (13.0 vs. 10.1 years; p > 0.05), and operative time was longer (55.0 vs. 35.0 minutes; p < 0.05). There was no conversion (OA to LA). The median length of hospital stay was significantly shorter in laparoscopy (3.0 vs. 2.0 days; p <
0.05). The median cost for LA was more expensive (W833, 836 vs. W751,398; p < 0.05). Even though there were higher costs and longer operative times with laparoscopic procedures, the shorter hospital stay was an advantage. (J Kor Assoc Pediatr Surg 9(1):41-44), 2003.
Index Words: Laparoscopy, Appendectomy, Children
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Correspondence : In Koo Kim, MD., Division of Pediatric Sur
gery, Asan Medical Center, University of Ulsan College of Me
dicine, 388-1 Poongnap-Dong, Sangpa-Ku, Seoul 138-736, Korea
Tel: 02-3010-3484, E-mail : [email protected]
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Table 1. Results of Laparoscopic and Open Appendectomy
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,,\-;7-!'1 LJo!'c 7.7-15.4AlI (""oJiIl: 1O.1'11l, ,,\-7J'i1;7-,Oc G.9-15.S
All (%O,Hk J:l.OAlll'lN. "11%-2 /l';,~ol 29.0- 72.0kg (%oJiiJ;
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Open appendectomy (n-11) Laparoscopic appendectomy (n-11)
Age (years) 10.1 (7.7-15.4)
Sex ratio (M:F)
Weight (kg)
Operative time (minutet
Hospital stay (days)'
Cost (It
Values are median * statistically significant, p<O.05
7:4
40.4 (290-72.0)
35.0 (20-80)
3 (2-4)
751,398 (581,142-906,695)
13.0 (6.9-15.5)
7:4
47.0 (240-77.0)
55.0 (30-75)
2 (2-3)
833,836(749,244-1,037,661 I
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I. Scmm K: Endoscopic AppendectomJ'. Endoscopy 15: 59-
64, 1983
2. Naffis D: Luparoscopic appendectom}/ in children. Sem
in Pediatr Surg 2:174-177, 1993
3. Valla .1-8, Steyaeti H: Laparoscopic appendectomy in
children, in Sa.'\: lv'MA, Georgeson KE, /v'qjmaldin A.
Vatta J-S(ed:;,): Endoscopic Surgery in Children, chap
29. Berlin, Gemlany, Springer, 1999, Pp234-235
4. Varlet F, Tm'dieu D, Limonne B, Metafiot H, Chavrier
Y: Laparoscopic versus open appendectomy in children-
comparative study of 403 cases. Eur J Pediatr Surg
4(6):333-337, 1994
5. el Ghoneimi A, Valla JS, Limonne B, Valla V, Montu
pet P, Chavrier Y, Grinda A: Laparoscopic appendec
tomy in children: report of 1,379 cases. J Pediatr Surg
29(6):786·789, 1994
6. Jurieic M, Bossavy JP, Izmd P, Cuq P, Vaysse P,
J uskiewenski S: Laparoscopic appendicectomy: case re
ports of vascular injury in 2 children. Em J Pediatr
Surg 4(6):327-328, 1994
7. Esposito C, Ascione G, Garipoli Y, De Bernardo G,
Esposito G: Complications of pediatric laparoscopic sur
ge/y. Surg Endosc 11(6):655-657, 1997
8. Foulds KA, Beasley SW, Maoate K: Factors that injl
uence length oj" stay qfier appendicectomy in children.
Aus! N Z .I Surg 70( 1 ):43·46, 2000
9. Mouret P, francois Y: Plea for cdioscopic appendec
tom}} in acute appendicitis. Chirurgie 119(8):436-440,
1993-1994
10. Olsen lB, Myren el, Haahr PE: Randomized study of
the value of laparoscopy before appendicectomy. Br J
Surg 80(7):922·923, 1993
11. Lejus C, Delile L, Plattner V, Baron M, Guillou S, He
loury Y, Souron R: Randomized, single hlinded trial oj"
laparoscopic versus open appendectomy in children:
ejjects on postoperative analgesia. Anesthesiology 84(4):
801·806, 1996
12. Lintula H, Kokki H, Vanamo K: Single hlind randomi
zed clinical trial of laparoscopic versus open appendi
cectomy in children. Br J Surg 88(4):510-514, 2001
13. Meguerditchian AN, Prasi1 P, Cloutier R, Leclerc S, Pe
loquin J, Roy G: Laparoscopic appendectomy in child
ren: A javorahle alternative in simple and complicated
appendicitis. 1 Pediatr Surg 37(5):695-698, 2002
14. Cm1ty TG Sr, Collins D, Losasso B, Lynch f, Brown
C: Laparoscopic appendectomy fur simple (lnd perjura
ted appendicitis in children: the procedure of choice? J
Pedia!r Surg 35( II): 1582·1585, 2000
15. Little DC, Custer MD, May m 1, Blalock SE, Cooney
DR: Laparoscopic Appendectomy An unnecessary and
e.r:pensive procedure in children? J Pediatr Surg 37(3):
310·317,2002
16. l:lJ-7o,loa, :§;:>:~~t 01 7o,l1':1, %Oa~~: 9:,:i o l- ~-1XI/A01 q.}rQ-of/
r!i0: el'i!A! J'f-'J;;jEj E/E/. ",o}2IA 8(2): 156-160,
2002
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