ABSTRACT
BACKGROUND: Complicated appendicitis (gangrenous or perforated) has been associated with increased risk for postoperative complications, especially intraabdominal abscess. Caution has been advised when attempting laparoscopic appendectomy for complicated appendicitis in children. The objective of our study was to assess the incidence of intraabdominal abscess formation after laparoscopic appendectomy in pediatric patients presenting with complicated appendicitis. METHODS: This is a retrospective review of 52 pediatric patients presenting with acute appendicitis at a single teaching institution who underwent laparoscopic appendectomy by a single surgeon. All laparoscopic procedures were completed without conversion. Treatment complications and outcomes were recorded for all cases. RESULTS: Five of the 52 patients (10%) had complicated appendicitis. One of the 5 patients (20%) developed intraabdominal abscess postoperatively and underwent laparoscopic drainage during the same admission. No other complications were noted. None of these patients was readmitted for wound infections or intraabdominal abscesses. The single postoperative abscess occurred early during our initial experience with laparoscopic appendectomy. CONCLUSION: Laparoscopic appendectomy seems to be a safe alternative for the treatment of complicated appendicitis in children. Caution is recommended during the initial experience of surgeons with this procedure, because the complication rate seems to be higher during the learning curve. Close postoperative follow-up and a high index of suspicion for development of complications is recommended. As surgeons' experience accumulates, the safety of the procedure seems to increase. A prospective, randomized trial is recommended to establish the role of laparoscopy in complicated appendicitis in the pediatric population.
Subject(s)
Abdominal Abscess/epidemiology , Appendectomy/methods , Appendicitis/surgery , Laparoscopy/methods , Abdominal Abscess/etiology , Adolescent , Appendicitis/complications , Child , Female , Humans , Incidence , Male , Retrospective Studies , Treatment OutcomeABSTRACT
A trephined stoma allows a quick postoperative recovery when a concomitant laparotomy is not necessary. However, both colostomies and ileostomies are associated with a significant short- and long-term complication rate. Review of 25 conventional trephine colostomies showed a complication rate of 20% over 5 years (three hernias and three prolapses in five patients). A laparoscopically assisted method for trephine stoma formation is described that overcomes the disadvantages of the conventional trephine technique; namely the tendency to enlarge the trephine to mobilize the mesentery, leading to prolapse; tension on an inadequately mobilized mesentery, leading to retraction; and difficulties in the orientation of an end stoma. This method was used to fashion six colostomies and one ileostomy with no complications. There was a shorter convalescence and initial stoma care was easier. This procedure is preferred for temporary or permanent stoma formation when a laparotomy is not necessary because it allows a precise trephine mobilization of the mesentery and confirmation of orientation of the bowel.
Subject(s)
Colostomy , Ileostomy , Laparoscopy/methods , Ostomy/methods , Anastomosis, Surgical , Colostomy/instrumentation , Colostomy/methods , Evaluation Studies as Topic , Humans , Ileostomy/instrumentation , Ileostomy/methods , Laparoscopes , Postoperative Complications/physiopathology , PrognosisABSTRACT
A 42-year-old man was operated with a clinical diagnosis of peptic ulcer but was found to have growth in the pyloric region. The pathology report on the gastrectomy specimen was Crohn's disease of the stomach with malignant lymphoma. Review of the literature indicates the rarity of this association.
