Appendicitis is the most common acute surgical disease in children. Due to a nonspecific presentation and progression of the disease, a significantly higher presentation of appendiceal perforation may be expected in young children. With perforation there is an elevated risk of intraabdominal abscess, wound infection, post-operative ileus, higher rates of readmission and longer length of stay. Laparoscopic appendectomy is the recommended first line treatment however many centers from developing countries are still in the early stages of adopting such an approach and do appendectomies in an open manner. This study outlines our institution’s experience with a laparoscopy-first approach in managing pediatric appendicitis. Surgical outcomes from laparoscopic and open procedures during the study period will be compared.

This retrospective cohort analysis encompasses all pediatric appendicitis cases at our institution from 2022 to 2023. As a major pediatric surgery referral center, there were a total of 273 cases during that period. Patient records were reviewed for surgical approach and outcomes.

The mean patient age was 11.87 years with a male:female ratio of 1.84. Average duration of symptoms prior to consult was 2.47 days. Most of the patients had complicated appendicitis (57.8% ruptured, 10.2% gangrenous). For the surgical approach, 42.9% underwent open appendectomy (OA) and 57.1% had LA with a conversion rate of 7.14%. Irrespective of disease severity, LA was superior to OA in terms of time to resume feeding (2.84 vs 4.07 days), post-op length of stay (5.29 vs 6.95 days), and surgical site infection rate (3.3% vs 16.2%). Operative times were not statistically different, with cases performed by fellows being faster than their resident counterparts by a few minutes. Other morbidities for LA included intraabdominal abscess (1.9%) and postoperative adhesions requiring adhesiolysis (1.3%), while the OA group reported 1 case each for adhesions, intraabdominal abscess, and incisional hernia.

This study highlights the advantages and complications of laparoscopic appendectomy in the pediatric population as implemented in a tertiary government center. It also provides preliminary data on a significant cohort of patients with complicated appendicitis who underwent laparoscopic management in the local setting.