Rising trend for keyhole appendix removal benefits kids

9 July 2018
New University of Sydney research finds laparoscopic (keyhole) appendicectomy for children improves outcomes and is associated with a shorter length of hospital stay, compared to open appendicectomy.

‘Keyhole’ appendicectomies produce better health outcomes in children up to 16 years finds a new study that compares the post-operative outcomes of open versus laparoscopic appendicectomies (LA).

Led by the University of Sydney, the study was published today in Medical Journal of Australia.

Paediatric appendicectomy for acute appendicitis is one of the most common emergency surgeries performed in children.

The study of 23,961 children found a significant increase in the proportion of laparoscopic (keyhole) appendicectomies performed in children between 2002 and 2013, rising from 12 percent to 86 percent. This is the first study to include and assess post-operative emergency department presentations.

“The results show laparoscopic appendicectomy for children improves outcomes and is associated with a shorter length of hospital stay, compared to open procedure,” said Dr Francisco Schneuer, Research Fellow from University of Sydney’s Clinical School at the Children’s Hospital at Westmead.

“Children with uncomplicated appendicitis have a lower risk of post-operative complications such as intestinal obstruction after LA compared to open appendicectomy.

“For cases of complicated appendicitis (with abscess, perforation or peritonitis), the risk of wound infections was lower for LA, but not of intestinal obstruction, or intra-abdominal abscess.

“However, LA patients have higher hospital re-admission rates or emergency department presentations related to symptoms such as abdominal pain and fever in children with uncomplicated appendicitis.

“This suggests that children may be discharged before post-operative symptoms have adequately resolved.”

Co-author Professor Andrew Holland from the University’s Clinical School at the Children’s Hospital at Westmead said: “This study tells us that laparoscopic appendicectomy is safe, with a reduced risk of adhesive bowel obstruction, but a higher risk of minor complications that require re-presentation for assessment or treatment.”

The study also found that post-operative outcomes for children managed in metropolitan, regional or rural general hospitals were not different from those who were treated in tertiary paediatric hospitals regardless of age.

Dr Susan Adams from the Sydney Children’s Hospital at Randwick and co-author of the study said: “This research is important because appendicitis in children is common and it is reassuring that children across NSW have access to safe services to have their appendicitis treated with up to date approaches, including laparoscopic appendicectomy.

“Children with appendicitis need to be treated at a hospital with the physical resources and skilled personnel to care for the child. While for some children this will mean being transferred to a children’s hospital in Sydney or Newcastle, for many this level of expertise can be accessed close to home, in the local hospital. 

Dr Schneuer added: “Our study supports the safety of undertaking paediatric appendicectomies outside tertiary paediatric hospitals, which reduces waiting times, delays in care, and unnecessary travel for families of children who need appendicectomies.”

Study details:

  • The study assessed and compared the post-operative outcomes of open and laparoscopic appendicectomy in children under 16 in a public or private hospital in New South Wales between January 2002 and December 2013.
  • Of 23,961 children in the study who underwent appendicectomy, 81 percent had uncomplicated appendicitis and 19 percent had appendicitis complicated by abscess, perforation, or peritonitis.
  • Post-appendicectomy outcomes were similar for most age groups and hospital types.
  • The study used health information from NSW state-wide administrative health datasets.

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