Laparoscopic appendicectomy in children: A trainee's perspective

• Published in: Annals of the Academy of Medicine, Singapore Vol. 35; no. 10; pp. 694 - 697
• Main Authors: Sai Prasad, T R, Chui, Chan Hon, Jacobsen, Anette Sundfor
• Format: Journal Article
• Language: English
• Published: Singapore 01.10.2006
• Subjects: Acute Disease; Adolescent; Appendectomy - education; Appendectomy - methods; Appendicitis - surgery; Child; Child, Preschool; Education, Medical, Graduate; Female; Hospitals, Pediatric - standards; Humans; Internship and Residency; Laparoscopy; Male; Retrospective Studies; Safety; Singapore; Singapore
• ISSN: 0304-4602; 0304-4602
• DOI: 10.47102/annals-acadmedsg.V35N10p694

The emergence of operative laparoscopy has brought a great demand for training surgical residents, but there are no clear guidelines regarding choice of procedure for training, proficiency assessment and accreditation. We aim to examine from a trainee's point of view, the safety and efficacy of laparoscopic appendicectomy (LA) as a laparoscopic training procedure. A retrospective analysis of all the consecutive cases of LA done by a trainee in paediatric laparoscopic surgery from September 2003 to February 2005 was done. A total of 70 consecutive patients (37 males and 33 females) aged 3 to 15 years (mean, 10.5 +/- 2.5) with suspected appendicitis underwent LA. Twelve (17.1%) patients had acute appendicitis, 25 (35.7%) had acute suppurative appendicitis adherent to the caecum with localised and/or pelvic pus pocketing, 29 (41.4%) had perforated appendicitis with generalised peritonitis and 4 (5.7%) had normal appendix [mesenteric adenitis (1), omental infarct (1), torted Meckel's diverticulum (1) and primary peritonitis (1)]. There were no operative complications and none required conversion to open surgery. The operative duration ranged from 25 to 110 minutes (mean, 55.6 +/- 23.4). There were two complications; one had adhesive intestinal obstruction and underwent successful laparoscopic adhesiolysis and one had umbilical wound infection. LA is a safe and effective laparoscopic training procedure, in addition to being effective for all stages of appendicitis, as well as concurrent lesions encountered in children with suspected appendicitis.