From
StayCurrentMD
Journal of Pediatric Surgery Article Review: March 2022
With Dr. Miko Bogannan & Dr. Scott Short · hosted by Dr. Ellen Encisco
Chapter 1 of 3 · Evidence & Research
Lap vs Open Appy
Laparoscopic versus Open Appendectomy for Complicated Appendicitis
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Non-complicated appendicitis is probably already treated by antibiotics in some centers.
If you dilate esophageal stenosis, you have a risk of rupture, which could be catastrophic.
Historically at University of Utah, diet was not initiated following appendicostomy creation until the day after surgery.
Many appendicostomy patients displayed clinical signs that they were ready to initiate diet immediately after surgery.
The meta-analysis included 4 randomized controlled trials and 36 case controlled trials comparing laparoscopic and open appendectomy for complicated appendicitis.
Laparoscopic appendectomy is associated with shorter length of stay, lower rate of surgical site infection, and lower overall complication rate compared to open appendectomy.
Rates of intra-abdominal abscess, post-operative fever, pneumonia, and ileus are similar between laparoscopic and open appendectomy groups.
Open appendectomy has shorter operative time compared to laparoscopic appendectomy.
In Turkey, surgeons prefer open appendectomies in nearly half of children, especially those with lower BMIs.
The Turkish series successfully treated 14 of 19 congenital esophageal stenosis patients with a median of 5 dilatations.
Three congenital esophageal stenosis patients required surgery after dilation attempts.
If esophageal stenosis is cartilaginous, don't try to dilate, just go to resect; if there's no cartilage, then dilate.
The Turkish team tried balloon dilatation for every congenital esophageal stenosis patient first, then moved to surgery based on results.
Surgery was indicated for congenital esophageal stenosis in cases with recurring lung infections, growth retardation, or when patient wasn't healthy enough for dilation program.
Out of 19 congenital esophageal stenosis patients, 16 were successful with balloon dilation, 3 required operation, and overall 17 were symptom-free after 48 months follow-up.
Up to 5 dilatations should be tried before considering operative treatment for congenital esophageal stenosis.
The expedited protocol reduced hospital stay after appendicostomy from 3 days to 1 day without increasing complications or unplanned hospital visits.
Having a protocol and standardization in care management can be beneficial even beyond the specific protocol details.