Laparoscopic appendectomy in children with abdominal drainage

Appendicitis is one of the most common causes of emergency abdominal surgery in children. It is characterized by inflammation of the appendix, a small tubular organ attached to the large intestine. If not treated promptly, an inflamed appendix can rupture, leading to serious complications such as peritonitis or abscess formation. At "Dobrobut" clinics, surgeons specialize in laparoscopic appendectomy—a minimally invasive approach that allows for the removal of the inflamed appendix without further trauma to surrounding tissues. This procedure is often accompanied by abdominal drainage to ensure fluid drainage and prevent infections, helping to optimize the recovery process and reduce the risk of complications.

When to See a Doctor

At the suspicion of appendicitis, early medical intervention is critical. Parents should seek immediate attention at the clinic or call for an ambulance if the child exhibits the following symptoms:

• Abdominal pain. It often starts near the navel and then shifts to the lower right quadrant of the abdomen, becoming sharp, which is a classic symptom of appendicitis.
• Nausea and vomiting often accompany the development of appendicitis and indicate inflammation of the digestive system.
• Fever—ranging from mild to significant—can indicate an infection in the abdominal cavity.
• Loss of appetite up to complete refusal of food—these are characteristic signs of appendicitis, as stomach discomfort hinders normal eating.
• Swelling or tenderness: The abdomen may be swollen, and touch or pressure may cause significant discomfort or pain.

Indications and Contraindications

Laparoscopic appendectomy with abdominal drainage is usually indicated in the following cases:

• Suspected appendicitis: Clinical and diagnostic data indicating appendicitis necessitate urgent surgical intervention.
• Perforation (rupture) of the appendix—an emergency surgery is required to remove the infected tissue and irrigate the abdominal cavity.
• Abscess formation near the appendix that requires drainage and removal to prevent further spread of infection.

Contraindications may include:

• Serious comorbidities such as severe cardiac or respiratory issues that may complicate surgical intervention and necessitate alternative solutions.
• Bleeding disorders that increase the risk of surgery and require additional precautions.

Diagnosis

To determine the need for laparoscopic appendectomy with abdominal drainage, the doctor conducts a physical examination that includes assessing the presence of abdominal pain, its location and intensity, and an ultrasound study to confirm inflammation or rupture of the appendix. Other imaging methods may be applied, especially if differential diagnosis is necessary. Blood tests are also conducted, the results of which can confirm the body's response to inflammation and infection.

Preparation

Preparation for laparoscopic appendectomy includes a preoperative consultation with the surgeon and anesthesiologist, during which parents can ask any questions regarding the surgery and postoperative care. Recommendations concerning nutrition before and after surgery, as well as hydration guidelines, are also provided.

How the Procedure is Performed

At "Dobrobut" clinics, laparoscopic appendectomy combined with abdominal drainage is performed as follows:

1. General anesthesia is administered, ensuring complete pain relief, relaxation, and comfort.
2. Small incisions are made in the abdomen for the introduction of the laparoscope and specialized surgical instruments. This minimally invasive approach reduces tissue trauma.
3. Removal of the appendix — using the images from the laparoscope monitor, the surgeon carefully excises the inflamed appendix, preventing further complications.
4. Drainage — a sterile drain is placed in the abdominal cavity to remove fluid and prevent infection, aiding the healing process post-surgery.
5. Incisions are closed using stitches or are bonded with special adhesive, resulting in minimal scarring and promoting a quicker recovery.

Recovery

Rehabilitation consists of several phases. Immediately after the operation, the child remains under the supervision of medical staff. Only after the patient wakes up and their condition stabilizes can they be transferred to a hospital room.

To ensure pain relief, age-appropriate medications are prescribed.

Feeding begins with liquids, gradually transitioning to regular food depending on the child's tolerance.

Follow-up assessments are conducted to evaluate healing and the functioning of the drains. Once the drains are removed, monitoring continues until full recovery. Physical activity is gradually reinstated with the doctor’s approval.

Complications

Possible complications can include the spread of infection, bleeding, and issues with drains (such as blockage or misplacement). Post-surgery, scar tissue and adhesions may form, but laparoscopic techniques significantly reduce this risk.

Prevention

While appendicitis cannot be completely prevented, parents can take certain measures to mitigate risks:

• Regular medical check-ups with a pediatrician help to identify potential gastrointestinal problems.
• Timely treatment of infections.
• Providing a diet rich in fiber and ensuring adequate fluid intake supports overall digestive health and reduces the likelihood of gastrointestinal diseases.

At "Dobrobut," the highest standards of care in pediatric surgery are upheld. The use of modern laparoscopic technologies ensures effective treatment, minimal patient discomfort, and a swift return to normal life.