Introduction: This article describes the specific features of the diagnostics and therapy for acute appendicitis in childhood. As a result of the rapid progression of appendicitis in children, in spite of extensive diagnostic possibilities, we still see significant rates of perforation or vice versa of the so-called negative appendectomies.
Patients and methods: Our own results (1,247 appendectomies) of 20 years (1987-2006) were retrospectively analysed. The patients had an average age of 10.3 years (range: 3 months-18 years).
Results: The perforation rate was approximately 8.5%, the non-positive appendectomy rate 15.5%. The laparoscopic approach amounted constantly to 20% in the last 5 years. The median length of hospitalisation was reduced from 9.1 (1987-1991) to nearly 5 days (2002-2006). The relevance of active observation by experienced surgeons in addition to ultrasonographic examinations of the abdomen is stressed.
Conclusion: The appendectomy in children can be performed either by an open or a laparoscopic approach. The expected advantage of the endoscopic procedure (due to the smaller trauma of access) could not be proven in our own patients, as well as in various prospective studies. The early diagnosis and therapy are still today a challenge for the attending doctors.