Comparison of Classical Open Appendectomy, Small Incision Appendectomy and Laparoscopic Appendectomy in Children with Uncomplicated Acute Appendicitis
Keywords:Appendectomy; Laparoscopic; Grid Iron; Small Incision; Children.
Background: The surgical anatomy of appendix coupled with a lax abdominal wall in children creates a
possibility of accomplishing an appendectomy using a small incision. The aim of the present study was to
compare the outcomes of classical grid iron, small incision and laparoscopic appendectomy in children with
uncomplicated acute appendicitis.
Method: A prospective comparative study was undertaken at a tertiary care hospital, where patients who
underwent either open (classical or small incision) or laparoscopic appendicectomy were studied and
compared for various intraoperative and postoperative parameters. The subjects selected for study were
children in the age group of 4 – 14 years of age, and were diagnosed as having simple acute appendicitis.
Results: Out of a total of 201 patients included in the study; 78 underwent appendectomy by classical Grid
iron incision, 62 by small incision and 67 by a conventional laparoscopic method. The baseline parameters
were similar in all the three groups. The mean operative time was significantly lower in small incision group.
There was no intra-operative complication noticed in any of the groups. Conversions were significantly
higher in the small incision group as compared to classical grid iron and laparoscopic approach. The mean
pain scores (visual analogue scale) were significantly decreased in the laparoscopic group. The mean hospital
stay and return to activities of daily life was significantly increased in the classical grid iron group.
Conclusion: Laparoscopic approach for appendectomy seems to be a clear winner in uncomplicated
paediatric appendicitis, but small incision approach provides an acceptable alternative, as compared to the
standard grid iron incision.