E. Harnish1, M. Schwab1, A. Tu1, C. Mueller1 1Stanford University, Palo Alto, CA, USA
Introduction: Laparoscopic appendectomy is undoubtedly one of the most common procedures performed on children around the world. Yet, methods for specimen removal vary widely. For instance, appendix removal can be accomplished via stapler or endoloop and is often determined by instrument availability as well as surgeon preference. Furthermore, the type of specimen retrieval device used also differs from surgeon to surgeon without much data to support any particular strategy. In this study, we assess our practice of laparoscopic appendectomy via Endoloop ligation plus and direct retrieval without specimen bags to demonstrate the feasibility of this approach.
Methods: A retrospective review over a ten-year period was performed on children who underwent a laparoscopic appendectomy at a single institution. All patients with a diagnosis of appendicitis were included and assessed for method of appendix ligation and removal as well as for intraoperative and postoperative outcomes.
Results: All patients identified tolerated laparoscopic surgery with minimal complications. Need for additional drainage or treatment for wound infections was rare and did not seem to be related to method of specimen removal or retrieval. While a trend toward the use of staplers was noted for older patients, no significant differences were identified by age or sex. Retrieval bags were more commonly used for perforated appendicitis and for specimens larger than 10mm.
Conclusion: There is relatively little evidence to support the use of staplers and specimen retrieval devices in children undergoing laparoscopic appendectomy for appendicitis. The findings of our survey of appendectomies performed with Endoloops without specimen retrieval devices demonstrate the feasibility of this minimalist approach, particularly for younger children with uncomplicated appendicitis.