Outcomes of Laparoscopic vs. Open Appendectomy in Children: A Multicenter Retrospective Analysis

Background: The clinical condition of appendicitis is a frequent surgical emergency in childhood, for which two principal forms of operative treatment are available: LA and OA. Although the technique of LA has been advocated due to less invasive route compared to OA for its treatment in pediatric patients, controversy continues regarding safety, efficacy and cost effectiveness of LA over OA in pediatric patients. Objective: Therefore, this study seeks to establish an LA vs OA comparison for pediatric patients with available multi centred data, in order to give practical recommendations for choice purposes. Methods: In the final analysis, 30 pediatric patients aged between 3 and 18 years who underwent either LA or OA during the period January 2015 to December 2020 were included in the study. Samples were obtained from several tertiary care centers; and the source data analyzed for operative time, length of stay, complication and readmission rates, and cost-utility. T-tests, ANOVA’s, chi-square tests and logistic regression tests were used to make comparisons of the outcomes of both surgical techniques. Results: The group of patients in the LA group has shown lesser operative time (45. 75 ± 14. 79 min vs 54. 89 ± 19. 62 min; p < 0. 001) and hospital stays (1. 51 ± 0. 70 days vs 3. 22 ± 1. 16 days; p < 0. 001) than the OA group. Further, LA was linked with less odds of postoperative complications (3. 69% vs. 9. 82%; p < 0. 001) as well as readmissions (2. 62% vs. 5. 09%; p = 0. 035). The overall study design along with logistic regression analysis revealed that there was a reduced risk of complications (p < 0. 001) in patients who underwent LA irrespective of their age and similarly there was a reduced risk of readmissions (p = 0. 024) in the same group of patients. Conclusion: In pediatric patients, laparoscopic appendectomy is superior to open appendectomy owing to shortest operative duration, shortest hospitalization, and lowest morbidity, and readmission rates. In agreement with these findings, LA has been preferred in pediatric appendicitis; however, each individual should be assessed in terms of the patient’s characteristics and surgical capacity.