Keyhole Surgery for Pediatric Appendicitis

By Dr. Lalit Parida, Consultant (Incharge) – Pediatric Surgery, Thumbay Hospital – Ajman

The appendix is a vestigial organ left behind by human evolution. While the appendix has no specific function in the human digestive system, it is situated along the bottom right side of the large intestine. There is no adverse reaction if it is missing or even if it is surgically removed.

Sometimes the appendix becomes blocked. Mucus trapped inside can allow bacteria to grow. That can lead to infection and inflammation (appendicitis). This illness is very common in children, teens, and young adults. The infection is usually bacterial in nature and allows the appendix to swell up inside the abdominal cavity. Eventually the appendix will rupture, spreading the bacterial infection to all organs in the abdominal cavity, eventually leading to a potentially dangerous health problem called peritonitis. A person with appendicitis may need an appendectomy – a surgery to remove a child’s appendix.

Appendicitis: A common condition in children

Appendicitis is one of the most common surgical conditions in children which I see in my practice. These children usually have abdominal or tummy pain, vomiting or nausea, fever, decreased appetite, diarrhea or constipation, or even urine problems. Certain blood tests like white blood cell count and c-reactive protein along with an ultrasound of the abdomen helps in establishing the diagnosis of appendicitis. It is important to operate upon these children early as the infected appendix may burst to result in what is known as perforated appendicitis. This will then increase the chance of infection inside the abdomen and usually prolongs the hospital stay for the child.

Laparoscopic Appendectomy: A case study

The parents of 7-year-old Sarah (name changed) were very concerned as their daughter was having stomach pain and vomiting for 2 days. But when she started also having a fever, they decided to take her to Thumbay Hospital, Ajman.

Sarah was examined by the Emergency department doctor at the hospital who suspected that she may be having appendicitis. As the Consultant Pediatric Surgeon, I attended Sarah’s case. After examining the child and conducting a few blood tests and ultrasound of the abdomen, I confirmed the diagnosis of appendicitis.

I then explained to the parents of Sarah about her condition and the urgent need for surgery. This initially came as a surprise to the parents and they were concerned about her future and skin scars. Comforting them, I explained the operative procedure in detail, eventually getting their consent for the surgery.

Sarah underwent a successful laparoscopic appendectomy and was discharged the very next day, in excellent condition. She visited the hospital after a few days for a routine checkup and was found to be back to her normal self. The parents were very happy and acknowledged that there were barely visible skin scars from the surgery in her abdomen.

How is Laparoscopic Appendectomy Different?

I use the keyhole method or Laparoscopic method to remove the infected appendix under general anesthesia. This involves making three small cuts in the abdomen and each of these cuts is just half a centimeter. We then put a small camera through one of the skin holes and take out the appendix with the help of other instruments. Even in the case of burst or perforated appendicitis, my choice is the key-hole method, as it is a lot easier to clean the abdomen of its infective fluids due to the bird’s eye view of the keyhole camera.

Some of the main advantages of Laparoscopic over conventional appendectomy are: reduced risk of wound infection, reduced postoperative pain, shorter hospital stay and more rapid return to normal activities.

Dr. Lalit Parida has more than 10 years of experience as a Consultant Pediatric Surgeon. He does all pediatric surgical procedures including newborn surgery. He has received his M.Ch degree in Pediatric Surgery from All India Institute of Medical Sciences (AIIMS) in New Delhi, which is a premier medical institute of India. He has also done advanced clinical fellowship training in Pediatric Surgical Oncology which is children’s cancer surgery from the world-famous Memorial Sloan-Kettering Cancer Center, New York and St. Jude Children’s Research Hospital, Memphis, USA.