Appendicitis is one of the most common surgical emergencies in children. The appendix, a small finger-like pouch attached to the cecum, can become inflamed due to obstruction by fecal matter, lymphoid hyperplasia, or infection. Pediatric appendicitis requires prompt diagnosis and surgical management because children often present late, leading to complications like perforation or peritonitis. Appendicectomy, the surgical removal of the appendix, remains the gold standard treatment.

Understanding Appendicitis in Children

Children are more prone to rapid progression of appendicitis because of the narrow lumen of their appendix and a poorly developed omentum that fails to localize infection. While adults may take several days to develop perforation, in children it can happen within 24–48 hours.

Common Symptoms

Abdominal pain starting around the umbilicus and migrating to the right lower quadrant

Loss of appetite and nausea

Vomiting and fever

Tenderness over McBurney’s point

Guarding and rigidity in advanced cases

Younger children may present with nonspecific symptoms like irritability, refusal to eat, or diarrhea, making diagnosis more challenging.

Diagnosis of Pediatric Appendicitis

Dr. R.K. Mishra and many surgical experts emphasize that timely and accurate diagnosis is key to preventing complications. Diagnostic steps include:

Clinical examination: Careful palpation to localize tenderness.

Blood tests: Elevated white cell count and CRP suggest infection.

Ultrasound: First-line imaging in children due to absence of radiation.

CT scan: Reserved for doubtful cases, though minimized in pediatrics due to radiation exposure.

Indications for Appendicectomy in Children

Appendicectomy is performed in the following situations:

Acute Appendicitis – the most common indication.

Complicated Appendicitis – when there is perforation, abscess, or peritonitis.

Incidental Appendicectomy – performed when appendix is found diseased during another surgery.

Recurrent Appendicitis – in children with repeated attacks.

Types of Appendicectomy
Open Appendicectomy

Traditionally performed through a small incision in the right lower abdomen.

The appendix is identified, mesoappendix divided, and the base tied with sutures.

Still widely used in resource-limited settings.

Laparoscopic Appendicectomy

Increasingly favored in children due to minimal access, faster recovery, and better cosmesis.

Involves placement of three small ports: one for the camera and two for working instruments.

The appendix is mobilized, the base is ligated with sutures or endoloops, and removed through a port.

Allows visualization of the whole abdomen, useful when diagnosis is uncertain.

Steps of Laparoscopic Appendicectomy in Children

Anesthesia & Positioning: General anesthesia with child placed supine.

Port Placement: 5–10 mm umbilical port for the laparoscope, and two 3–5 mm working ports.

Exploration: Inspection of abdominal cavity to confirm appendicitis.

Dissection: Appendix mobilized and mesoappendix divided using bipolar cautery or ultrasonic shears.

Ligation of Base: The appendix base is ligated with endoloops, staplers, or extracorporeal knots.

Removal: Appendix extracted through the umbilical port using a specimen bag to prevent contamination.

Closure: Peritoneal cavity irrigated if perforation exists, and ports are closed.

Advantages of Laparoscopic Appendicectomy in Children

Smaller incisions with better cosmetic outcome

Less postoperative pain

Faster recovery and early discharge

Ability to examine entire abdomen and rule out other causes of pain

Lower rate of wound infection compared to open surgery

Risks and Complications

Though appendicectomy is generally safe, risks include:

Bleeding or injury to bowel and surrounding structures

Wound infection or intra-abdominal abscess

Postoperative ileus

Adhesion formation leading to intestinal obstruction (rare)

Anesthetic risks, especially in very young children

Prompt recognition and management reduce long-term complications.

Postoperative Care in Pediatric Patients

Early ambulation is encouraged to prevent complications.

Oral fluids are started within 6–12 hours, advancing to soft diet as tolerated.

Analgesics are prescribed for pain relief.

Antibiotics are given if perforation or abscess was present.

Most uncomplicated cases are discharged within 24–48 hours.

Parents are advised to watch for fever, abdominal pain, or wound discharge after discharge. Follow-up visits ensure proper healing and monitoring.

Prognosis and Outcomes

When treated promptly, children recover completely after appendicectomy. Laparoscopic appendicectomy allows many children to return to school and normal activities within a week. In complicated cases with perforation, recovery may take longer, but outcomes remain excellent with appropriate management.

Conclusion

Appendicectomy for appendicitis in children remains the definitive treatment to prevent life-threatening complications like perforation and peritonitis. With the growing role of minimal access surgery, laparoscopic appendicectomy is becoming the preferred technique in pediatric patients, offering faster recovery and minimal scarring.

By combining timely diagnosis, skilled surgical intervention, and proper postoperative care, children can return to normal life quickly and safely. Appendicectomy, whether open or laparoscopic, continues to be one of the most rewarding and life-saving procedures in pediatric surgery.