Keyhole surgery for appendix removal in kids leads to better outcomes

17 July 2018

A new study published in the Medical Journal of Australia has shown that appendix removal by keyhole surgery, known medically as laparoscopic appendicectomy, leads to better health outcomes and reduced hospitals stays for children when compared to open surgery.

Led by researchers at the University of Sydney and the Sydney Children’s Hospitals Network, the study of 23,961 children in NSW used data linkage to analyse appendicectomies performed between 2002 and 2013, as well as post-operative emergency department presentations.

The study drew on health information from administrative health datasets, in both private and public hospitals across NSW.  The anlysis of the anonymised linked hospital and emergency department data was conducted by members of the Child Population Health Research group led by Professor Natasha Nassar at the Children’s Hospital at Westmead’s Clinical School of the University of Sydney.

Over the period analysed, the rate of laparoscopic appendicectomy (LA) compared to open appendicectomy greatly increased, rising from 12 percent in 2002 to 86 percent in 2013.

“The results show laparoscopic appendicectomy for children improves outcomes and is associated with a shorter length of hospital stay, compared to open procedure,” said Dr Francisco Schneuer, research fellow in the Child Population Health Research group.

“Children with uncomplicated appendicitis have a lower risk of post-operative complications such as intestinal obstruction after LA compared to open appendicectomy.

“However, LA patients have higher hospital re-admission rates or emergency department presentations related to symptoms such as abdominal pain and fever in children with uncomplicated appendicitis. This suggests that children may be discharged before post-operative symptoms have adequately resolved.”

The study also found that post-operative outcomes for children managed in metropolitan, regional or rural general hospitals were not different from those who were treated in tertiary paediatric hospitals regardless of age.

Dr Susan Adams, paediatric surgeon from Sydney Children’s Hospital, Randwick, and co-author of the study said:

“This research is important because appendicitis in children is common and it is reassuring that children across NSW have access to safe services to have their appendicitis treated with up to date approaches, including laparoscopic appendicectomy.

“Children with appendicitis need to be treated at a hospital with the physical resources and skilled personnel to care for the child. While for some children this will mean being transferred to a children’s hospital in Sydney or Newcastle, for many this level of expertise can be accessed close to home, in the local hospital.

Dr Schneuer added: “Our study supports the safety of undertaking paediatric appendicectomies outside tertiary paediatric hospitals, which reduces waiting times, delays in care, and unnecessary travel for families of children who need appendicectomies.”

Pictured: Some members of the Department of General Surgery, Sydney Children's Hospital, Randwick.  The general surgery services offered place an emphasis on keyhole surgery.

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