New Method of Laparoscopic Appendectomy in Children (Woundless Technique)

Abstract

Purpose: We have performed a standard appendectomy using a "woundless" technique in cases of childhood appendicitis. We report the technique and its effectiveness for laparoscopic appendectomy in children with appendicitis. Methods: We used an extracorporeal appendectomy technique, which involved inserting a laparoscope and forceps together through the umbilicus, grasping the appendix and pulling it to the level of the umbilicus, and excising the appendix outside the abdominal cavity. Eighty-six cases diagnosed with appendicitis between August 2005 and March 2009 were studied. We defined the woundless group as the cases in which the "woundless" technique was used. Cases of appendicitis with abscess around the appendix or with panperitonitis were defined as serious cases, while the others were defined as mild cases. Results: Sixty-eight cases (79.1%) underwent the "woundless" technique. The procedure was converted to a pneumoperitoneal laparoscopic method in 17 cases (19.8%). Due to a huge abscess mass, one case (1.2%) underwent an open procedure from the beginning. The woundless group consisted of 66 mild and 2 serious cases. The operative time was 34.7±12.5min. The length of the postoperative stay was 2.2±0.9 days. Only one patient in the woundless group had wound infection because of an intra-abdominal abscess. Conclusions: The "woundless" technique for children has a cosmetic advantage and is practicable in most mild cases of appendicitis. This technique can be easily converted to a pneumoperitoneal laparoscopic method. Therefore, we recommend the "woundless" technique as a standard appendectomy procedure in children.