Laparoscopic surgery for severe appendicitis in children: An effect and safety analysis

Abstract

BACKGROUND

Severe appendicitis in children represents a critical condition that advances quickly, necessitating prompt and effective intervention to facilitate smooth postoperative recovery.

AIM

To examine the efficacy and safety of laparoscopic surgery for the treatment of severe appendicitis in pediatric patients.

METHODS

The study included 105 pediatric cases treated surgically for severe appendicitis between September 2023 and January 2026, comprising 50 cases in the control group receiving traditional open appendectomy and 55 cases in the research group undergoing laparoscopic appendectomy. Comparative analyses between the groups assessed various dimensions, including surgical metrics (operative duration, incision length, intraoperative blood loss), clinical indices (postoperative analgesic utilization rate, gastrointestinal function recovery time, length of hospital stay, hospitalization expenses), complications (inflammatory intestinal obstruction, mesenteric adhesion, intraperitoneal abscess, incision infection), inflammatory markers [interleukin (IL)-6, IL-8, C-reactive protein], stress response indicators (epinephrine, norepinephrine, cortisol), and gastrointestinal hormone levels (motilin, gastrin).

RESULTS

The findings revealed that the research group exhibited significantly lower values compared to the control group concerning operative duration, incision length, intraoperative bleeding, postoperative analgesic utilization rate, gastrointestinal function recovery time, and length of hospital stay, while hospitalization expenses remained comparable between the two groups. Additionally, lower levels of IL-6, IL-8, C-reactive protein, epinephrine, norepinephrine, and cortisol were observed in the research group, alongside elevated contents of motilin and gastrin following surgery.

CONCLUSION

Laparoscopic appendectomy demonstrates effectiveness and high clinical safety in the management of severe appendicitis in children.

Key Words: Laparoscopic surgery; Severe appendicitis in children; Effect; Safety; Retrospective analysis

Core Tip: This study assesses the effectiveness and safety of conventional open appendectomy compared to laparoscopic appendectomy in managing severe appendicitis, including gangrenous appendicitis, perforated appendicitis, and periappendiceal abscess, in children aged 6-12 years. Laparoscopic surgery yields superior clinical benefits, as evidenced by smaller incisions, shorter surgical durations, reduced intraoperative bleeding, lower requirements for postoperative analgesics, faster gastrointestinal functional recovery, and decreased length of hospital stay, all without incurring additional hospitalization costs. Furthermore, laparoscopic surgery significantly mitigates inflammation and stress responses while actively regulating postoperative gastrointestinal hormone levels.

INTRODUCTION

Appendicitis can affect individuals of all ages and is frequently encountered in emergency departments, strongly associated with obstruction of the appendiceal cavity[1,2]. The 2021 global disease burden report indicated that there were 2193020 new cases of pediatric appendicitis, representing 12.93% of incidences across all age groups[3]. Furthermore, the rate of diagnostic error in appendicitis decreases with age: (1) 70%-100% for children under 3 years; (2) 19%-57% for preschoolers; (3) 12%-28% for school-aged children; and (4) Less than 15% for adolescents[4]. These variations contribute to delayed diagnoses and a high misdiagnosis rate among children, increasing the likelihood of suppuration and perforation of the appendix, which may lead to diffuse peritonitis or periappendiceal abscess, culminating in severe or complicated appendicitis[5]. Major types of severe appendicitis include gangrenous appendicitis, perforated appendicitis, and periappendiceal abscess, all of which can progress rapidly. Without timely intervention, these conditions may result in various complications that adversely affect patient prognosis[6]. A systematic review has established a correlation between the high-risk group of pediatric appendicitis and an increased likelihood of postoperative infectious complications and extended hospital stays[7]. Appendectomy remains the standard treatment for severe appendicitis, encompassing both open appendectomy (OA) and laparoscopic appendectomy (LA). Although the former effectively prevents disease relapse by completely removing the affected tissue, it may cause significant physiological trauma and delay postoperative recovery[8]. In contrast, the latter, characterized by a high recovery rate, accelerated convalescence, and a low incidence of complications, is applicable to patients without contraindications; however, it does carry the risk of conversion to open surgery due to insufficient visualization or potential iatrogenic injury[9,10]. Research by Patel et al[11] on complicated and non-complicated appendicitis in adults demonstrates that LA offers superior surgical efficacy compared to OA, particularly in complicated cases, effectively preventing ileus and reducing hospitalization duration. The systematic review and meta-analysis conducted by Neogi et al[12] further indicate that laparoscopic surgery for severe appendicitis in pediatric patients is linked to a significantly lower overall complication rate compared to OA, alongside reduced requirements for pain management and intravenous antibiotics.

Despite these findings, the efficacy and safety of laparoscopic surgery for severe appendicitis in children remain subjects of debate and require further verification. The novelty of the present study lies in its multi-dimensional validation of the clinical effectiveness and safety of laparoscopic surgery for severe appendicitis in pediatric patients, encompassing surgical metrics, clinical indices, complications, inflammatory markers, stress responses, and gastrointestinal hormones, thereby providing a new and reliable reference for the management of such cases.

MATERIALS AND METHODS

Case selection

Eligibility criteria for this study included: (1) Meeting the diagnostic criteria for severe appendicitis (gangrenous appendicitis, perforated appendicitis, or periappendiceal abscess)[13]; (2) Being a pediatric patient aged between 6 years and 12 years; (3) Having surgical candidacy classified as American Society of Anesthesiologists Classification I-II[14]; (4) A lack of prior medication before admission; (5) Absence of communication or cognitive barriers; and (6) The availability of intact medical records.

Ineligibility was defined by the following factors: (1) A history of abdominal surgery; (2) Conversion from laparoscopic to open surgery; (3) Presence of concurrent malignant tumors; (4) Hematologic diseases or coagulation/immune dysfunction; (5) Contraindications to surgery or anesthesia (e.g., hemodynamic instability, severe systemic peritonitis); (6) Symptoms of respiratory failure; (7) Other acute abdominal conditions (intussusception, ileus, primary peritonitis, Meckel’s diverticulitis); (8) Vital organ abnormalities; and (9) Systemic infectious diseases (e.g., sepsis, bacteremia, severe pneumonia).

This retrospective study selected 105 pediatric cases of severe appendicitis treated at Children’s Hospital of Nanjing Medical University from September 2023 to January 2026, strictly adhering to the eligibility and ineligibility criteria outlined above. The control group comprised 50 children undergoing traditional OA, while the research group included 55 cases treated with LA. The study cohorts demonstrated well-balanced distributions of general data, rendering them clinically comparable (P > 0.05).

Intervening methods

Upon admission, both groups of pediatric patients underwent evaluations, including blood routine tests, coagulation function assessments, an electrocardiogram, and abdominal ultrasound (or computed tomography) to establish a clear diagnosis and evaluate surgical tolerance.

For the control group, traditional OA was performed. After general anesthesia was initiated with endotracheal intubation, a right McBurney’s point incision was made to access the abdomen. The procedure involved a layered incision through the skin, subcutaneous tissue, and external oblique aponeurosis, followed by blunt dissection of the obliquus internus abdominis and transversus abdominis to enter the peritoneal cavity. A retractor was used to adequately expose the surgical field, allowing identification and confirmation of the ileocecal region, along with localization of the appendix along the colon. The appendix was then dissected using either an anterograde or retrograde approach. The apex of the mesoappendix was clamped with vascular forceps, and the mesenteric vessels were transected and ligated at the base of the appendix. A clamp was placed 0.3-0.5 cm from the base of the appendix towards the cecum, followed by excision of the appendix. After routine disinfection of the stump, a purse-string suture and embedding were performed. In cases where significant edema or gangrene was observed at the base of the appendix, simple ligation or figure-of-eight suture ligation with reinforcement was performed without forced embedding. Postoperatively, the abdominal cavity was thoroughly irrigated with 0.9% sodium chloride solution, particularly in the pelvic cavity and bilateral iliac fossae. An abdominal drain was inserted based on the amount of pus and the degree of inflammation, and the incision was closed in layers. Routine antibiotics were administered postoperatively to prevent infection. Specifically, piperacillin/tazobactam (80-100 mg/kg/time, calculated based on piperacillin, every 8 hours) was infused intravenously immediately following the procedure. Transition to oral amoxicillin/clavulanic acid (25-45 mg/kg/time, every 12 hours) was made if the patient maintained a normal body temperature (< 38 °C) for more than 24 hours, exhibited total enteral nutrition tolerance, and showed a decreased leukocyte count. The total duration of antibiotic therapy was 5 days, with discontinuation on the 5^th postoperative day. If the empirical regimen proved ineffective, the antibiotic therapy was adjusted according to intraoperative abdominal pus cultures and drug sensitivity test results.

The research group underwent LA using the same anesthesia protocol as the control group. The patient was positioned recumbent in a Trendelenburg position, with both the operator and the assistant positioned at the child’s left side. An arc-shaped incision was made at the upper or lower edge of the umbilicus, followed by the establishment of a CO₂ pneumoperitoneum via puncture with a pneumoperitoneum needle. Pressure was maintained at 8-12 mmHg, adjusted for age and weight. Subsequently, a Trocar and laparoscope were inserted. Exploration of the abdominal cavity was conducted under direct visualization with the laparoscope, allowing for assessment of the appendix’s position, degree of inflammation, and the presence of perforation or seroperitoneum. A Trocar and operating forceps were inserted into the left lower abdomen, and a third auxiliary operating port was added above the pubic symphysis or in the right lower abdomen when necessary. Following thorough exploration and identification of the appendix lesion, a non-destructive gripper was used to elevate the appendix, facilitating separation of the mucosal tissue and surrounding adhesions, thus fully exposing the mesoappendix. Management of the mesoappendix was conducted using an ultrasonic scalpel or electrocoagulation hook to systematically coagulate and sever the mesenteric blood vessels from the apex to the base of the appendix. Care was taken to operate closely against the appendix to preserve the blood supply to the ileocecal region. In instances of mesoappendix hypertrophy or significant inflammation, a ligating clip was employed to clamp the major blood vessels. After separation and ligation of the appendix base, a double ligature was applied using absorbable coils or sutures. The appendix was then excised using an electric hook, positioned approximately 0.5 cm from the distal end of the ligation. The mucosa of the gastric stump was disinfected via electrocautery, and routine embedding was not performed. In cases where the appendix base was gangrenous and perforated, laparoscopic simple ligation or suture reinforcement was performed. Following removal of the appendix, the abdominal and pelvic cavities were thoroughly flushed with 0.9% sodium chloride solution, and any pus and flushing fluid were completely aspirated. After confirming the absence of active bleeding or accidental injury, the decision regarding abdominal drain placement was made based on the volume of pus and extent of infection. CO₂ gas was expelled from the abdominal cavity, and suturing of the incision was performed. The postoperative anti-infection protocol was consistent with that employed in the control group.

Data collection and outcome measures

Surgical metrics included the assessment of operative duration, incision length, and intraoperative blood loss (IBL) for both groups.

Other clinical indices encompassed specific measures such as the postoperative analgesic utilization rate, gastrointestinal function recovery time, length of hospital stay, and hospitalization expenses.

Complications were quantified by counting the number of patients who developed postoperative inflammatory intestinal obstruction, mesenteric adhesion, intraperitoneal abscess (IAA), and incision infection, with the total incidence calculated accordingly.

Inflammation markers were determined by venous blood sampling (5 mL) from all children under fasting conditions before treatment and three days post-treatment. The serum, separated via centrifugation, was analyzed for interleukin (IL)-6, IL-8, and C-reactive protein (CRP) measurements using enzyme-linked immunosorbent assay.

For stress response evaluation, cortisol (Cor) levels were quantified using radioimmunoassay, and epinephrine (EPI) and norepinephrine (NE) levels were assessed through modified immunofluorescence, both before treatment and three days thereafter.

Gastrointestinal hormone indices for gastrin (GAS) and motilin (MTL) were measured by radioimmunoassay before treatment and on day three following treatment.

Statistical analysis

Measurement data were statistically described as mean ± SD. Inter-group differences were assessed using the independent samples t-test, whereas within-group differences were evaluated with the paired t-test. Count data were expressed as n (%) and analyzed for differences between groups using the χ² test. Statistical analyses were conducted using SPSS 26.0, with a significance level set at P < 0.05.

RESULTS

Patient baseline information

To assess group comparability, baseline data for the children were analyzed, revealing balanced distributions in sex, age, weight, onset-to-operation time, and disease type between the groups (P > 0.05; Table 1).

Table 1 Baseline patient data, n (%)/mean ± SD/mean (interquartile range).

Variable	Control group (n = 50)	Research group (n = 55)	χ2/Z/t	P value
Sex			0.273	0.602
Male	28 (56.00)	28 (50.91)
Female	22 (44.00)	27 (49.09)
Age (years)	9.00 (8.00, 11.00)	9.00 (7.00, 10.00)	-1.029	0.304
Weight (kg)	21.44 ± 2.79	21.82 ± 2.78	0.698	0.487
Onset-to-operation time (hours)	10.86 ± 3.68	10.56 ± 3.58	0.423	0.673
Disease type			1.317	0.518
Gangrenous appendicitis	26 (52.00)	28 (50.91)
Perforated appendicitis	17 (34.00)	19 (34.55)
Periappendiceal abscess	7 (14.00)	8 (14.55)

Surgical metrics

The research group exhibited statistically lower values compared to the control group in several surgical metrics: (1) Operative duration (74.20 ± 22.51 minutes vs 93.72 ± 26.31 minutes); (2) Incision length (2.49 ± 0.83 cm vs 6.82 ± 2.56 cm); and (3) IBL (12.51 ± 3.40 mL vs 26.92 ± 3.39 mL; P < 0.001; Table 2).

Table 2 Surgical metrics, mean ± SD.

Variable	Control group (n = 50)	Research group (n = 55)	t	P value
Operative duration (minutes)	93.72 ± 26.31	74.20 ± 22.51	4.096	< 0.001
Incision length (cm)	6.82 ± 2.56	2.49 ± 0.83	11.881	< 0.001
IBL (mL)	26.92 ± 3.39	12.51 ± 3.40	21.720	< 0.001

IBL: Intraoperative blood loss.

Other clinical indices

Regarding clinical outcomes, the postoperative analgesic utilization rate was lower in the research group (7.27% vs 22.00%), while gastrointestinal function recovery time was faster [2.00 (2.00, 3.00) days vs 4.00 (3.00, 5.00) days], and the hospital stay was shorter (6.55 ± 2.39 days vs 8.00 ± 2.76 days; P < 0.05). Hospitalization expenses, however, were comparable between the groups (9700.75 ± 1670.36 CNY vs 9580.90 ± 1486.13 CNY; P > 0.05; Table 3).

Table 3 Operation-related indexes, n (%)/mean ± SD/mean (interquartile range).

Variable	Control group (n = 50)	Research group (n = 55)	Fisher’s/Z/t	P value
Postoperative analgesic utilization rate (%)	11 (22.00)	4 (7.27)		0.049
Gastrointestinal function recovery time (days)	4.00 (3.00, 5.00)	2.00 (2.00, 3.00)	-4.369	< 0.001
Hospital stay (days)	8.00 ± 2.76	6.55 ± 2.39	2.884	0.005
Hospitalization cost (CNY)	9580.90 ± 1486.13	9700.75 ± 1670.36	0.387	0.700

Complications

Complications were documented, with postoperative inflammatory intestinal obstruction, mesenteric adhesion, IAA, and incision infection occurring in 3 cases, 3 cases, 2 cases, and 2 cases in the control group, respectively, while the research group exhibited 0 case, 1 case, 0 case, and 1 case. The total complication incidence in the research group was significantly lower (3.64%) compared to that in the control group (20.00%; P = 0.012; Table 4).

Table 4 Postoperative complications across groups, n (%).

Variable	Control group (n = 50)	Research group (n = 55)	P value
Inflammatory intestinal obstruction	3 (6.00)	0 (0.00)
Mesenteric adhesion	3 (6.00)	1 (1.82)
IAA	2 (4.00)	0 (0.00)
Incision infection	2 (4.00)	1 (1.82)
Total	10 (20.00)	2 (3.64)	0.012

IAA: Intraperitoneal abscess.

Comparative evaluation of immunocytokines

Inflammatory marker data showed preoperative IL-6 levels of 14.38 ± 3.06 ng/L in the control group and 13.42 ± 2.87 ng/L in the research group, increasing to 31.20 ± 8.28 ng/L and 24.20 ± 7.07 ng/L, respectively, after treatment. IL-8 levels also increased from baseline to postoperative levels (control group: 7.88 ± 3.31 ng/L becomes 25.68 ± 8.30 ng/L; research group: 8.13 ± 2.89 ng/L becomes 22.33 ± 8.52 ng/L). A similar increase was observed for CRP (control group: 36.46 ± 7.42 mg/L becomes 63.38 ± 15.26 mg/L; research group: 36.44 ± 9.56 mg/L becomes 52.82 ± 14.23 mg/L). No significant differences in baseline levels of IL-6, IL-8, or CRP were noted between the study cohorts (P > 0.05). Postoperatively, significant elevations in these inflammatory markers were observed across groups (P < 0.05), with the research group demonstrating lower levels of IL-6, IL-8, and CRP compared to the controls (P < 0.05; Figure 1).

Figure 1 Analysis of inflammatory markers. A: Interleukin-6 changes pre-operation and post-operation; B: Pre-operative and post-operative alterations in interleukin-8; C: C-reactive protein changes before and after surgery. ^aP < 0.05 and ^bP < 0.01 vs the pre-operative level; ^cP < 0.05 vs control. IL: Interleukin; CRP: C-reactive protein.

Stress response assessment

Measurements indicated that preoperatively, EPI levels were 120.04 ± 12.61 pmol/L in the control group and 117.35 ± 14.09 pmol/L in the research group, increasing to 345.96 ± 51.39 pmol/L and 254.16 ± 32.09 pmol/L, respectively, after treatment. NE levels were documented as 101.42 ± 21.73 pmol/L and 101.18 ± 26.48 pmol/L before treatment, and 186.90 ± 39.40 pmol/L and 151.58 ± 30.63 pmol/L after treatment, respectively. Cor levels also rose postoperatively in both groups (control group: 177.68 ± 24.60 nmol/L becomes 278.04 ± 38.79 nmol/L; research group: 174.89 ± 22.94 nmol/L becomes 178.00 ± 27.78 nmol/L). Baseline EPI, NE, and Cor levels were comparable between the cohorts (P > 0.05). Post-surgery, all stress-related parameters exhibited significant increases in both groups (P < 0.05), with levels in the research group being lower than those in the control group (P < 0.05; Figure 2).

Figure 2 Stress response of the two groups. A: Epinephrine changes pre-operation and post-operation; B: Pre-operative and post-operative alterations in norepinephrine; C: Cortisol changes before and after surgery. ^aP < 0.05 and ^bP < 0.01 vs the pre-operative level; ^cP < 0.05 vs control. EPI: Epinephrine; NE: Norepinephrine; Cor: Cortisol.

Gastrointestinal hormone indexes

MTL levels in the control and research groups were 128.38 ± 14.92 pg/mL and 120.96 ± 24.57 pg/mL before treatment, respectively, decreasing to 91.32 ± 13.12 pg/mL and 110.11 ± 15.28 pg/mL post-treatment. Concerning GAS, preoperative levels were recorded at 228.32 ± 28.29 pg/mL in the control group and 229.73 ± 28.10 pg/mL in the research group, which were subsequently reduced to 175.76 ± 18.95 pg/mL and 220.78 ± 16.08 pg/mL, respectively, following surgery. No statistical significance was observed between the groups regarding preoperative MTL and GAS levels (P > 0.05). Postoperatively, both cohorts exhibited significantly lower levels of gastrointestinal hormone indexes (P < 0.05). The inter-group comparison revealed that the research group demonstrated higher postoperative MTL and GAS levels (P < 0.05; Figure 3).

Figure 3 Gastrointestinal hormone indexes of the two groups. A: Motilin changes pre-operation and post-operation across groups; B: Pre-operative and post-operative alterations in gastrin. ^aP < 0.05 and ^bP < 0.01 vs the pre-operative level; ^cP < 0.05 vs control. MTL: Motilin; GAS: Gastrin.

DISCUSSION

This study confirms that laparoscopic surgery for severe appendicitis in 6-12-year-old children offers greater clinical advantages compared to open surgery in terms of clinical outcomes and safety, which is detailed herein.

Firstly, LA for severe appendicitis in children was associated with shorter operative durations, reduced incision lengths, and less IBL, supporting the findings of Yu et al[15]. In comparison to OA, LA resulted in lower postoperative analgesic utilization rates, expedited gastrointestinal function recovery, and faster hospital discharges, while hospitalization expenses remained comparable. These benefits may be attributed to the minimally invasive nature of LA, characterized by smaller incisions. Additionally, the laparoscopic lens-assisted observation during LA facilitates rapid lesion localization and precise appendectomy, minimizing the impact on surrounding normal tissues and enhancing procedural safety, ultimately aiding in quicker recovery for the child. The high-definition and magnified view afforded by laparoscopic surgery aids in meticulous dissection and hemostasis, while the use of advanced equipment such as ultrasonic scalpels effectively addresses mesoappendiceal issues, further reducing IBL. Moreover, LA is effective in mitigating surgery-induced abnormal elevations in inflammatory and stress responses and in correcting post-operative decreases in gastrointestinal hormones, which collectively expedite gastrointestinal functional recovery and shorten hospitalization duration. Zitouni et al[16] noted comparable results in their retrospective study, observing that laparoscopic surgery significantly reduced postoperative analgesic dependence compared to open surgery in children under 14 with severe appendicitis. Lipping et al[17] also found that laparoscopic surgery in pregnant women with acute appendicitis correlated with shorter operative durations and hospitalization times. A study conducted in a tertiary medical center in Kalaburagi City reported that laparoscopic surgery for acute appendicitis decreased the incidence of surgical site infections, shortened hospital stays, and enhanced functional recovery[18], which aligns with our findings. However, the study by Nepal et al[19] presented contrasting results, indicating that laparoscopic surgery led to prolonged postoperative recovery and increased costs compared to open surgery in acute appendicitis patients. This disparity may stem from their distinct study populations, which included adults or a mixed demographic, while this research specifically addresses severe appendicitis in children. In pediatric cases, factors such as the hypoplasia of the omentum majus, small appendiceal lumen, and reduced self-defense capacity amplify the minimally invasive advantages of laparoscopy, with a stronger offset effect of reduced hospital stay on total costs. From a safety perspective, laparoscopic surgery for severe appendicitis in children was associated with a lower overall complication rate, including inflammatory intestinal obstruction, mesenteric adhesion, IAA, and incision infection. This may be attributed to the comprehensive exploration of the abdominal cavity afforded by LA, which lowers the risks of incisional infections and fat liquefaction, subsequently reducing the formation of IAAs and preventing postoperative complications. Moreover, the increase in postoperative inflammatory markers and stress parameters is less pronounced with LA than with OA, thereby minimizing disruption to the body’s homeostasis and decreasing the likelihood of postoperative complications. As noted by Bulut and Ucar[20], laparoscopic surgery for acute appendicitis in patients aged 20-89 demonstrates a lower complication rate and significantly shorter operative durations and hospitalization times, similar to our observations.

IL-6, IL-8, and CRP were the inflammation markers assessed in this study. It was found that laparoscopic surgery for severe appendicitis in children significantly inhibited the abnormal increase in these inflammatory markers three days post-operation, indicating its superior inhibitory effect on serum inflammation. This outcome is attributable to the advanced techniques employed in laparoscopic surgery, including shorter incisions, minimal tissue exposure, and reduced operative duration, all of which result in less trauma to the patient’s body and subsequently help to mitigate inflammatory reactions. Liu and Xu[21] demonstrated that laparoscopic surgery is more effective than open surgery in reducing levels of CRP, procalcitonin, IL-6, and tumor necrosis factor-α, further supporting the conclusion of a more pronounced inflammatory inhibitory effect associated with laparoscopic procedures, consistent with findings from this study. Regarding stress response assessment, levels of EPI, NE, and Cor were measured. Surgical procedures represent a significant stressor, often triggering the activation of the hypothalamus-pituitary-adrenal axis, which can lead to heightened levels of EPI, NE, and Cor[22]. Evaluation revealed that pediatric patients undergoing laparoscopic surgery for severe appendicitis exhibited significantly reduced stress responses related to the operation. This reduced response may be linked to less extensive damage to the child's body during laparoscopic surgery. Research by Liu et al[23] also indicated that fast-track surgery significantly lowered Cor levels in children with acute appendicitis undergoing laparoscopic intervention, suggesting that fast-track approaches can enhance surgical stress management in this patient population. With respect to gastrointestinal hormone indices, both MTL and GAS, key hormones for regulating gastrointestinal function[24], were analyzed. This study found that laparoscopic surgery mitigated the substantial reductions in MTL and GAS levels typically induced by surgery, thus promoting improved gastrointestinal function recovery in pediatric patients.

Several limitations of this study warrant attention for future research. Firstly, the sample consisted solely of children aged 6-12 years with severe appendicitis, excluding pediatric cases aged under 6 or over 12. Future studies should expand participant recruitment to evaluate the clinical effectiveness of laparoscopic surgery in diverse age groups. Secondly, the study did not assess children’s sleep quality or quality of life following interventions with the two surgical modalities. Additional analyses in these areas could elucidate further clinical advantages associated with laparoscopic surgery. Moreover, the retrospective design of the study involved non-random assignment of patients, potentially introducing confounding factors (such as surgeon’s experience and family preferences) that may affect surgical method choices and outcome measures. Prospective randomized controlled trials are necessary to mitigate the impact of such confounding variables. Additionally, the limited sample size resulted in a small number of reported complications, highlighting the need for large-scale, multicenter, prospective randomized controlled trials to ensure statistical stability. Finally, a five-year follow-up is essential to ascertain the long-term prognostic effects of laparoscopic surgery.

CONCLUSION

In conclusion, laparoscopic surgery for severe appendicitis in children aged 6-12 is associated with shorter operative durations, reduced incision lengths, decreased IBL, and lower postoperative analgesic utilization rates. This approach also facilitates quicker gastrointestinal function recovery and shorter hospital stays, without significantly increasing hospitalization expenses while ensuring enhanced clinical safety. Furthermore, it effectively inhibits inflammatory and stress responses and alleviates the suppression of gastrointestinal hormone levels following surgery.