All operations were accomplished on emergency basis All children

All operations were accomplished on emergency basis. All children with suspected appendicitis were managed according to a standard preoperative protocol such as mechanical cleaning of the umbilicus with noncolored octenidine dihydrochloride (Octenisept) and a loading i.v.-dose of metronidazole and of cefuroxime within 15 minutes before starting surgery [6]. 4. Results Between August 2005 and December 2008, 262 children underwent SPA, including 146 males (55.7%) and 116 females (44.3%). Median age at operation was 11.4 years (range, 1.1�C15.9). Closure of the appendiceal stump using two vicryl RB-1 sutures at a cost of USD 7.5 each was successful in all patients. Conversion to open appendectomy occurred in 35 children (13.4%) and to conventional 3-trocar laparoscopic appendectomy in 9 children (3.

4%). In a previous study, we reported about complications and main outcomes in correlation to histological results [6]. No insufficiency of the appendiceal stump was observed by ultrasound. During a followup of 69 months (range, 30�C69), six obese children (2.3%, body mass index > 95th percentile) developed an intraabdominal abscess after perforated appendicitis. One child (0.4%) required surgical drainage, and the other five children (1.1%) responded to conservative treatment. No recurrence of intraabdominal abscess was noted to date. Neither a stapler (cost: USD 276) nor endoloops (cost: USD 89) were used. There was no mortality related to SPA in this series. Median operating time was 55 minutes (range, 15.0�C160.0). The median length of hospital stay was 4 days (range, 3.

0�C18.0). As referred earlier [6], the operating surgeon was in 71.7% a resident under the direct supervision of a board certified senior pediatric surgeon. 5. Discussion The increasing pressure of national healthcare insurance to contain costs of inpatient hospitalization aroused our interest in performing this cost-benefit analysis of SPA. Since this year, diagnosis-related group (DRG) was introduced in Switzerland. Now, a flat rate reimbursement replaced the traditional cost-based reimbursement system called TARMED (Tarif m��dical) [7, 8]. Appendicitis is the most common cause of acute abdominal disease in children [9]. Despite several advantages of laparoscopic appendectomy (LA) such as less pain, earlier discharge, better cosmesis, and earlier return to normal activities [10], open appendectomy (OA) still represents a standard surgical technique [11, 12].

In particular, SPA has not yet evolved as gold standard for the treatment of acute appendicitis. Brefeldin_A Compared to OA, LA using the three-trocar technique has been shown to induce less postoperative pain and faster recovery of the bowel function but seems to be associated with a higher rate of intraabdominal abscess formation, especially in perforated appendicitis [13], and with higher costs [14].

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