Imran Alam

BackgroundAcute appendicitis remains the most frequent paediatric surgical emergency worldwide. Although laparoscopic appendicectomy has progressively supplanted the traditional open approach in specialist paediatric centres, evidence regarding its outcomes in non-specialist District General Hospitals remains limited. In such settings, appendicectomies in children are frequently performed by general surgeons, introducing potential variability in outcomes related to surgeon experience and institutional resources.MethodsA retrospective cohort study was conducted at Wrightington, Wigan and Leigh NHS Foundation Trust, United Kingdom. All patients aged ≤16 years who underwent emergency appendicectomy for suspected acute appendicitis between 1st January 2016 and 31st August 2025 were included. The primary outcome was the immediate postoperative complications within the same admission and a 30-day postoperative admission rate, including surgical site infection, intra-abdominal abscess, and postoperative ileus. Secondary outcomes included operative duration, length of hospital stay, and conversion rate. Statistical analysis was performed using SPSS v28.0. A p-value <0.05 was considered statistically significant.ResultsA total of 254 paediatric patients underwent appendicectomy for suspected acute appendicitis between January 2016 and August 2025. Following exclusion of incomplete records, 237 patients were included in the final analysis, comprising 199 (84.0%) open appendicectomies (OA), 36 (15.2%) laparoscopic appendicectomies (LA), and 2 (0.8%) laparoscopic procedures converted to open. The mean patient age was 10.9 ± 2.7 years, with a male predominance (63.3%). The mean American Society of Anesthesiologists (ASA) grade was 1.21 in the OA group and 1.25 in the LA group. Preoperative imaging was performed in 101 (42.6%) cases, most commonly ultrasound, with comparable diagnostic accuracy between groups (p = 0.99). The mean operative duration was 70.0 minutes, with median durations of 63.8, 97.2, and 195.0 minutes for open, laparoscopic, and converted cases, respectively. Complicated appendicitis occurred in 58 (28.9%) OA and 10 (27.8%) LA cases (p = 0.89). Drain placement was required in 26 (12.9%) OA and 7 (19.4%) LA cases (p = 0.31). The overall postoperative complication rate was 23 (9.7%), most frequently due to postoperative ileus (8 (3.4%)) and intra-abdominal abscess (8 (3.4%)), with no significant difference between surgical approaches. The 30-day readmission rate was 26 (10.9%), predominantly for intra-abdominal collections (10 (4.2%)) and postoperative pain (7 (3.0%)). The negative appendicectomy rate was 13 (5.5%), lower than national averages (~10-13%). The majority of procedures (174 (73.4%)) were performed by registrars under consultant supervision, reflecting the reproducibility of both approaches in a training environment. No intraoperative access-related complications or major adverse events were recorded.ConclusionLaparoscopic appendicectomy performed by general surgeons in a District General Hospital is safe and effective for paediatric patients, demonstrating outcomes comparable to open surgery with low complication and negative appendicectomy rates. The high proportion of registrar-performed procedures highlights its reproducibility in a training environment. These findings support the routine use of laparoscopic appendicectomy in non-specialist centres with appropriate training and resources.