Introduction: The emergence of operative laparoscopy has brought a great demand for training surgical residents, but there are no clear guidelines regarding choice of procedure for training, proficiency assessment and accreditation. We aim to examine from a trainee’s point of view, the safety and efficacy of laparoscopic appendicectomy (LA) as a laparoscopic training procedure.Materials and Methods: A retrospective analysis of all the consecutive cases of LA done by a trainee in paediatric laparoscopic surgery from September 2003 to February 2005 was done. Results: A total of 70 consecutive patients (37 males and 33 females) aged 3 to 15 years (mean, 10.5 ± 2.5) with suspected appendicitis underwent LA. Twelve (17.1%) patients had acute appendicitis, 25 (35.7%) had acute suppurative appendicitis adherent to the caecum with localised and/or pelvic pus pocketing, 29 (41.4%) had perforated appendicitis with generalised peritonitis and 4 (5.7%) had normal appendix [mesenteric adenitis (1), omental infarct (1), torted Meckel’s diverticulum (1) and primary peritonitis (1)]. There were no operative complications and none required conversion to open surgery. The operative duration ranged from 25 to 110 minutes (mean, 55.6 ± 23.4). There were two complications; one had adhesive intestinal obstruction and underwent successful laparoscopic adhesiolysis and one had umbilical wound infection. Conclusions: LA is a safe and effective laparoscopic training procedure, in addition to being effective for all stages of appendicitis, as well as concurrent lesions encountered in children with suspected appendicitis.
The advent of laparoendoscopic surgery in children has opened new avenues of treatment with added benefits but at the same time demands adequate training for its safe execution. Laparoscopic techniques can be safely incorporated into surgical residency training using graded and supervised clinical programmes.
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