ORIGINAL SCIENTIFIC REPORT
Trends in the Use of Laparoscopic Versus Open Paediatric
Appendicectomy: A Regional 12-Year Study and a National
N. R. Bhatt
A. E. Gillis
K. C. Conlon
P. F. Ridgway
Internationale de Chirurgie 2018
Background In adult patients, it is generally accepted that laparoscopic appendicectomy (LA) is the predominant
operative pathway in treating acute appendicitis. The case for a similar pathway utilising LA in children is less clear.
We investigate usage, trends and complications after LA in children in a single co-located adult/paediatric centre
with contemporaneous adults as controls.
Methods A retrospective case–control study was conducted over 12 years including patients who underwent
appendicectomy, and the paediatric series (\16 years) was divided into age-groups-based quartiles. An anonymous
questionnaire-based national survey was circulated among general and paediatric surgeons.
Results Of the 5784 appendicectomy patients, 2960 were children. LA rate in paediatric appendicitis was 65%.
Yearly trends in LA reached a steady state in both groups after 2010 (D 0–1%/year). Rates of LA and LA IAA
(respectively) differed signiﬁcantly between age groups: 60, 3% (0–9 years); 65, 1% (10–13 years); 71, 2%
(14–16 years) and 93, 3% ([16 years) (p = 0.001, 0.02). The national survey showed respondents believed LA was
not superior to OA in paediatric patients except in terms of cosmesis. There was strong support in the use of LA in
older children and children [40 kg.
Conclusion The use of LA in paediatric appendicectomies in the study region is similar to international rates, but not
increasing over time. Irish surgeons still favour OA in younger children and prefer a case-by-case approach rather LA
being the preferred pathway. This is despite the regional and international evidence showing favourable outcomes
with LA in children.
In adult surgery, it is now accepted that laparoscopic
appendicectomy (LA) is the predominant pathway in many
developed healthcare districts worldwide. LA confers
advantages over open appendicectomy (OA) with quicker
discharge, return to normal functioning and lower wound
infection rates [1–4]. In the initial learning curve in the late
1990s and early 2000s, there were higher intra-abdominal
abscess (IAA) rates observed with LA. At that time, some
thought that the technique maybe contributing to more
pelvic complications. This led to a call for mandatory
conversion to open procedures where perforated
Meetings: British Association of Paediatric Surgeons (BAPS) 2017.
& P. F. Ridgway
Department of Surgery, Adelaide and Meath Hospital,
Tallaght, Dublin, Ireland
Department of Surgery, Trinity College Dublin, Tallaght
University Hospital, Dublin 24, Ireland
World J Surg