Pediatrics · Surgery ·
Laparoscopic and Open Appendectomy Show Similar Outcomes in Children With Complex Appendicitis
A multicentre prospective cohort study in 38 Dutch hospitals compared laparoscopic and open appendectomy in children with complex appendicitis without an appendiceal mass or abscess. Three-month complication rates were similar, but open surgery was associated with lower medical costs; the open-surgery group was small.
- Three-month complication rates did not differ significantly.
- Open appendectomy was associated with lower medical costs.
- Only 46 children underwent open surgery.
- Other measured outcomes were similar at three months.
This subgroup analysis of the CAPP prospective cohort included children younger than 18 years with suspected complex appendicitis without an appendiceal mass or abscess. Of 1,308 enrolled children, 1,299 were analysed and 989 met the subgroup criteria. The primary outcome was postoperative complications within three months. Propensity analysis was used to adjust for baseline differences and treatment selection.
Laparoscopic appendectomy was performed in 943 children (95.3%) and open appendectomy in 46 (4.7%). Complications occurred in 14.4% and 15.2%, respectively; the difference was not statistically significant (weighted OR 0.68, 95% CI 0.17–1.87), and complication severity did not differ. Hospitalization, unscheduled healthcare visits, disability days, parental work absence, quality of life and patient satisfaction were also similar. Medical costs were lower with open surgery, with a mean difference of €868.
The findings do not establish equivalence between approaches: the open-surgery group was small, limiting comparability despite adjustment. The prospective cohort provides evidence on outcomes in this population, but the results alone do not establish that one approach should replace the other.
In practice
For children with complex appendicitis without an appendiceal mass or abscess, this prospective cohort found no statistically significant difference between laparoscopic and open appendectomy in three-month complications or several recovery and patient-reported outcomes. The findings do not establish equivalence or support changing surgical approach: laparoscopic surgery accounted for 95.3% of cases, while only 46 children underwent open surgery, leaving limited comparability even after propensity adjustment. Open surgery was associated with lower medical costs in this cohort.
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Surgical Endoscopy: Outcomes of laparoscopic versus open appendectomy in children with complex appendicitis without appendiceal mass and/or abscess: a subgroup analysis from a multicentre prospective cohort study (CAPP study) ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.