Conservative Treatment of Pediatric Peri-appendiceal Abscess Followed by Selective Laparoscopic Appendectomy:Report of 22 Cases
10.3969/j.issn.1009-6604.2025.01.009
- VernacularTitle:小儿阑尾周围脓肿保守治疗后择期腹腔镜阑尾切除:附22例报告
- Author:
Xuelai LIU
1
;
Zhen CHEN
1
;
Kaikun HUANG
1
Author Information
1. 首都儿科研究所附属儿童医院普通外科,北京 100020
- Publication Type:Journal Article
- Keywords:
Peri-appendiceal abscess;
Laparoscopy;
Selective appendectomy;
Children
- From:
Chinese Journal of Minimally Invasive Surgery
2025;25(1):52-56
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the experience of performing selective laparoscopic appendectomy in re-admission children who had been given conservative treatment for acute appendicitis complicated with peri-appendiceal abscess.Methods From September 2019 to July 2024,22 patients with acute appendicitis complicated with peri-appendiceal abscess underwent three port laparoscopic appendectomy after receiving conservative treatment for 6-14 weeks.Their age ranged 5-14 years old,with an average of 8.5 years old.A 5 mm trocar and a 30° laparoscope were inserted through a midline umbilical incision,and 5 mm trocars and forceps were placed at the suprapubic area,lateral to the left rectus abdominis,and 3-5 cm below the umbilicus.Adequate adhesiolysis was performed,including detaching the omentum from the pelvic sidewall,separating the ileocecal region from the omentum,and freeing the appendix from the lateral peritoneum and the mesenteric tissue of the terminal ileum to expose the affected appendix.The mesoappendix and the base of the appendix were then ligated and transected.Results The operations in all the 22 cases were successful.The surgical time ranged 50-150 min(mean,75.5±10.0 min).The patients were able to mobilize independently at 6-8 h postoperatively,resumed passing gas and consumed clear liquids within 1-1.5 d.The postoperative hospital stay was 3-6 d,with an average of 4 d.Pathological reports indicated chronic appendicitis with necrotizing perforation.Follow-ups lasted for 2-13 months(mean,6 months),with no reports of abdominal pain,fever,incision infection,adhesive intestinal obstruction,residual appendicitis,or pelvic abscess.Conclusions For children with acute appendicitis complicated with peri-appendiceal abscess who have received conservative treatment,effective adhesiolysis within the abdominal and pelvic cavities during selective laparoscopic appendectomy is crucial,which is also the primary reason for a relatively prolonged surgical time.Adhesions are primarily located between the omentum and pelvic sidewall,between the ileocecal region and omentum,and between the appendix and lateral peritoneum as well as the mesentery of the terminal ileum.Adequate adhesiolysis followed by appendectomy can effectively alleviate symptoms such as abdominal pain.
