Acute Appendicitis In Children: Laparoscopy vs. Open Surgery

A] What Is Acute Appendicitis in Children?

Acute paediatric appendicitis is a condition that is marked by the severe inflammation of the appendix in children. The inflammation here is a result of both blockage and bacterial infection. Appendicitis is most common during adolescence and the teenage years, with the highest incidence in children aged 10-18, though it frequently affects school-aged children as young as 5 years. Statistically, boys have a higher risk of developing this condition than girls. Diagnosing acute appendicitis requires a detailed history of your symptoms, which we will explain later. First, let’s try to understand the causes.

B] What Causes Paediatric Appendicitis?

Understanding the causes of paediatric appendicitis assists parents in seeking timely care for their children. Some common causes of paediatric appendicitis include:

Swollen Lymphoid Tissue

Your appendix includes a higher amount of lymphoid tissue that helps strengthen your immune system. It’s during infections such as colds, flu, or throat or stomach infections that this tissue becomes enlarged. This, in turn, blocks your appendix, preventing normal drainage. With bacteria slowly multiplying inside the appendix, it eventually leads to inflammation, causing appendicitis.

A Hard Piece of Stool

Dry and hard stool can also travel into the opening of your appendix and create a blockage. The bacteria here eventually build up, causing pain, swelling, and inflammation. If not treated in time, the infection can further increase and even burst in certain cases. A simple idea to prevent this is to increase your water and fibre intake.

A Twist in the Appendix

Although uncommon, the appendix can twist on itself, causing appendicitis. When this happens, the supply of blood to the appendix gets cut off. With insufficient blood supply, the tissues of the appendix start to swell and eventually become inflamed. When not treated in time, this could lead to a serious case of infection inside your abdomen.

C] What Risks Are Associated With Untreated Paediatric Appendicitis?

Paediatric appendicitis is not a condition to be ignored, as it can become life-threatening. Here are some risks that are associated with paediatric appendicitis:

Perforation

Perforation is the most serious risk that occurs when your inflamed appendix bursts. This happens when your appendix gets filled with pus, and the pressure constantly builds inside the lumen. If left untreated, the infected material can spill into your abdominal cavity.

Peritonitis

In peritonitis, the leaked bacteria in your abdomen create an infection in the lining of your abdominal cavity (peritoneum). This causes symptoms such as severe abdominal pain, high fever, nausea, and vomiting. If peritonitis is not treated promptly, the infection can spread throughout the body and lead to sepsis, a life-threatening condition.

Abdominal Pain (Symptom)

While children may not say it, it’s important to note the changes that they point towards. Initial signs might point towards a dull pain or cramps. Other signs, such as holding their stomach, crying and avoiding movement, can also be observed by the parents.

Gastrointestinal Concerns

Constipation and bloating are some of the common symptoms caused as a result of the ongoing inflammation. In some cases, episodes of vomiting might further increase your discomfort. Temporary paralytic ileus is another condition to be aware of.

Refer to our blog on appendicitis in children to know about the risks that you should be aware of.

D] Which Treatment Options Are Available for Paediatric Appendicitis?

Laparoscopic appendectomy and open appendectomy have emerged as the two main options that are safe yet effective. Let’s try to understand these, along with their associated benefits:

Laparoscopic Appendectomy

Laparoscopic appendectomy is considered a minimally invasive technique used for the treatment of paediatric appendicitis. The procedure entails the use of general anaesthesia performed under the supervision of a surgeon. In this, a small camera is used to get a magnified view. Instead of one large cut, the procedure involves the use of multiple small incisions. For a better understanding, refer to this article on laparoscopic appendectomy to get in-depth information.

Key benefits of laparoscopic appendectomy:

• Reduced Postoperative Pain
  As a laparoscopic appendectomy is a minimally invasive procedure, it involves less pain compared to other surgeries. Even after surgery, less tenderness can be felt around the treated area.
• Short Hospital Stay
  A major advantage of laparoscopic surgery is that it has a short hospital stay. Most children are able to regain their bowel function quite soon. A hospital stay of only two days is required in most cases.
• Quick Return to Normal Activities
  With laparoscopic appendectomy, children are able to return to their normal activities quite soon. Walking, moving, and light school activities can be resumed in a few days.
• Low Risk of Infections
  As the incisions are small, the chances of infections are significantly low. This also reduces the chances of scarring or postoperative hernias. With a short recovery time, laparoscopy offers reliable wound healing.

Robot-Assisted Laparoscopic Appendectomy

Robot-assisted laparoscopy is another minimally invasive surgical technique often used to treat complex cases. The technique involves the use of robotic arms equipped with specialised instruments that ensure precision in every movement. The use of a high-definition camera enables a magnified view, which reduces the chances of injury. This surgery is especially helpful in cases of an inflamed appendix.

Key benefits of robotic-assisted laparoscopy:

• Preferred for Complex Cases
  Robotic-assisted laparoscopy is an emerging approach for complex cases involving perforated appendicitis, abscesses, peritonitis, or widespread infections, thanks to tremor-free precision from robotic instruments.
• Depth Perception and a Detailed View
  Robotic-assisted laparoscopy enables superior visualisation, as it makes use of a high-definition 3D camera. Structures such as intestines, blood vessels, and the bladder can be viewed with realistic depth perception due to this.
• Reduced Chances of Infection
  The risk of infections such as peritonitis or sepsis can be reduced with robotic-assisted laparoscopy, lowering the likelihood of emergency reoperations. This technique also allows for precise drainage of abscesses and pus.
• Minimally Scarring
  Robotic-assisted laparoscopy has a better cosmetic appeal when compared to traditional surgeries. The scars left by this surgery are barely noticeable. This is because of the tiny keyhole incisions that cause minimal tissue damage.

At Dr. Gursev, we specialise in robot-assisted techniques for challenging paediatric surgeries. For more information, visit our dedicated page on robot-assisted laparoscopy.

E] Recovery Process After Surgery

Your recovery time will depend on the severity of your infection. While recovery from an open appendectomy usually requires more time, here are some other factors to consider:

• Diet: Clear liquids such as water, soups and rehydration powders are usually focused upon. Digestible foods like khichdi, curd, or mashed vegetables can be slowly introduced. Oily or junk food items need to be avoided.
• Light Activities: Light activities, such as walking, can be introduced slowly. Activities involving rough play should be avoided, as they can disturb your internal healing or even trigger infections.
• Follow-Up: A follow-up after the first week is always recommended to ensure that the child’s recovery is proceeding smoothly. Proper wound-care instructions also need to be followed. You need to consult your doctor to know about the exact steps required for your recovery process.