Abstract
Introduction Management of appendicitis in children has changed remarkably over the last decade.
The proven benefits of laparoscopic appendectomy (LA) over the open operation have
made LA increasingly popular for pediatric patients. To date, no national clinical
practice guideline is available for pediatric LA in Germany and the operation is not
standardized. Thus, the aim of our study was to evaluate the current status of pediatric
LA in Germany.
Materials and Methods An internet-based survey was conducted on pediatric LA among all 98 registered pediatric
surgical units in Germany, comprising 22 questions with regard to utilization and
subjective appraisal of LA, technical standards, perioperative treatment, and training
aspects.
Results The survey was completed by 71 of the 98 units (72%). Technical infrastructure for
LA was provided in all units, but only in 79% of the units was LA, the standard approach
for appendectomy. Overall quality of LA was rated better compared with open appendectomy
by 52% units, equivalent by 38% and worse by 3%. The three-port technique was used
by 90% of the units; 10% used a single-port approach. Dissection of the mesoappendix
was done with bipolar coagulation in 55%, monopolar coagulation in 24%, harmonic knife
in 6%, and endostaplers in 11% of the units. Closure of the appendiceal stump was
performed using endoloops in 57%, ligations in 3%, endostaplers in 39%, and harmonic
knife in 1%. Removal of the appendix was done through the port by 79%, using a retrieval
bag by 18%, whereas in 3% it was removed directly through laparotomy. In case of appendiceal
perforation, an intra-abdominal drain was placed in 65%. Perioperative antibiotic
treatment for nonperforated appendicitis was given as a single shot in 33% of the
units, for 24 hours in 17%, for 3 days in 39%, and for 5 to 7 days in 11%. LA was
performed by a trainee under supervision in 87%, by a board approved pediatric surgeon
in 2%, by an attending pediatric surgeon in 7%, and by the surgeon-in-chief in 4%
of the units. For 93% of the sample, LA was an essential part of pediatric surgical
training.
Conclusion LA is the favored surgical method for pediatric appendectomy in Germany. However,
technical details, perioperative therapy and implementation into training programs
remain inconsistent. An effort has to be made to establish national clinical practice
guidelines to achieve standardization of LA.
Keywords
appendicitis - appendectomy - laparoscopy - children - clinical practice guidelines
