Pediatric Appendectomy in a Resource-Limited Setting: Laparoscopy Versus Laparotomy (Clinical Study)

Cheikh Tidiane Mbaye [1] *, Cheikh Diouf [1] , Florent Tshibwid A Zeng [2] , Mohamed Thom Diagne [3] , Mory Sangare [1] , Assane Sarr [1] , Christ Momo Tsague [1] , Omar Mbaye [1] , Amadou Moustapha Sar [3] , Mohamed Dieng [3] , Alassane Baro [3] , Ousmane Dabo [3] , Ibrahima Diallo [3]

[1] Unit of Pediatric Surgery, Ziguinchor Regional Hospital Center, Ziguinchor, Senegal

[2] Department of Pediatric Surgery, El Hadj Ibrahima Niass Regional Hospital Center, Kaolack, Senegal

[3] Department of General Surgery, Ziguinchor Regional Hospital Center, Ziguinchor,Senegal

Keywords

Appendectomy

Comparative trial

Laparoscopic surgery

Open laparotomy

Abbreviations

HIC - High-income country

LIMC - Low, middle-income country

Abstract

Introduction: Laparoscopy has increasingly become popular in the treatment of acute appendicitis. Despite its many advantages, it is not yet a routine practice in low-income countries like Senegal. Scarcity of research papers from Africa on the comparative benefits of laparoscopy has prompted the present study.

Methods: This is a descriptive and analytical prospective study over 24 months, from January 2022 to December 2023, in the pediatric surgical units of La Paix Hospital and of the Regional Hospital of Ziguinchor.

Results: This study includes 64 appendectomies (29 laparoscopy and 35 open). The mean age was 12 years (range 5-15 yr). There were 41 males and 23 females. The appendix was in the classic position in 77% of cases. The mean delay of therapeutic intervention was 16 hr for laparoscopy and 8 hr for laparotomy (p=0.001). The mean operating time was 87 min for laparoscopy and 46 min for laparotomy (p<0.001). Significant postoperative pain was noted in 2 patients after laparoscopy and in 7 after laparotomy (p=0.126). The mean hospital stay was 36 hr for laparoscopy and 65 hr for laparotomy (p<0.001). There were no complications after laparoscopy while 5 complications were registered after laparotomy, representing 14% (p=0.043).

Conclusion: Laparoscopic appendectomy in children appears to have considerable advantage over laparotomy in a resource-limitted setting.