Appendicitis, Perforated Appendicitis, Gangrenous Appendicitis, Peritonitis
Conditions
Keywords
Laparoscopic appendectomy, Open appendectomy, Complicated appendicitis, Pediatric appendicitis, Surgical site infection, Intra-abdominal abscess, Minimally invasive surgery
Brief summary
Acute appendicitis is one of the most common surgical emergencies in children. In complicated cases, where the appendix has perforated, become gangrenous, or caused peritonitis and purulent contamination, determining the optimal surgical approach remains an important clinical question. While laparoscopic appendectomy is widely used for uncomplicated cases, this study aims to evaluate its safety, clinical effectiveness, and postoperative outcomes compared with conventional open appendectomy in children with complicated appendicitis. A total of 100 pediatric patients diagnosed with complicated acute appendicitis will participate in this prospective comparative study, divided into two groups: * Group A: 50 patients undergoing laparoscopic appendectomy using a standard minimally invasive three-port technique. * Group B: 50 patients undergoing conventional open appendectomy via a standard right lower-quadrant incision. The primary goal is to compare the overall rate of postoperative complications between the two operative techniques. Researchers will also assess secondary outcomes, including operative time, intraoperative complications, conversion to open surgery, postoperative pain, time to resume oral feeding, duration of intravenous antibiotics, length of hospital stay, wound infections, intra-abdominal abscesses, bowel obstruction, readmissions, and reoperations. All participants will be evaluated during their hospital admission and followed up for 30 days postoperatively.
Interventions
PROCEDURELaparoscopic Appendectomy
Laparoscopic appendectomy performed under general anesthesia via a three-port technique (periumbilical camera port using Hasson open technique, 5 mm right lower quadrant port, and 10 mm suprapubic port). The mesoappendix is dissected, and the appendicular artery is skeletonized, secured with clips, and divided. The appendicular base is secured using three endoloops and divided between the second and third loop. The appendix is extracted in an endobag through the umbilical port. Peritoneal lavage, pus aspiration, and drain placement are performed based on operative findings. Incisions are closed in layers.
PROCEDUREOpen Appendectomy
Conventional open appendectomy performed under general anesthesia through a standard right lower-quadrant incision (e.g., McBurney or Lanz). The cecum and appendix are mobilized into the field. The mesoappendix and appendicular artery are ligated and divided, followed by ligation and division of the appendicular base. Peritoneal contamination is managed with peritoneal toilet, suction, and drainage as indicated by operative findings. The wound is closed in anatomical layers.
Sponsors
Assiut University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
1 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Pediatric patients with acute appendicitis requiring operative management. * Intraoperative confirmation of complicated appendicitis. * Patients within the pediatric age range adopted by the study center. * Written informed consent from the parent or legal guardian.
Exclusion criteria
* Uncomplicated acute appendicitis. * Appendicular mass managed conservatively. * Appendicular abscess managed initially by drainage without appendectomy. * Previous major abdominal surgery likely to interfere with laparoscopic access. * Severe cardiopulmonary disease contraindicating pneumoperitoneum. * Bleeding disorders or other major contraindications to surgery. * Refusal of consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Postoperative Complications | 30 days postoperatively | Calculated as the percentage of pediatric patients who develop at least one postoperative complication (including surgical-site infection, intra-abdominal abscess or collection, prolonged postoperative ileus, mechanical bowel obstruction, or need for reoperation) following appendectomy. |
Outcome results
None listed