The article generalizes the first experience in successful laparoscopic
appendectomies in children carried out by the method suggested by F. Götz et al. which we modified and adapted to pediatric practice. In all cases of acute
appendicitis the laparoscopic manipulation began with the diagnostic stageo by performing two abdominal
punctures with small-diameter
trocars. Laparoscopic
appendectomy was undertaken only in recognized destructive
appendicitis. It was conducted 205 times in children 2 to 14 years old in various localization of the vermiform process, including subhepatic and retroperineal. Complicated forms of
appendicitis were encountered in 52 patients. Nineteen children had generalized purulent
appendicitis, 18 had circumscribed
peritonitis, and 11 children had a loose infiltrate and signs of circumscribed
peritonitis. A peri-appendicular
abscess was found in the remaining 4 children. All endoscopic operations were completed successfully. In 205 endoscopically removed vermiform processes the clinical and morphological signs were in full agreement, with the exception of one case in which secondary inflammatory changes were determined in the process when the clinical diagnosis was phlegmonous
appendicitis. Six complications occurred in the postoperative period: abdominal infiltrate in two patients, which was cured by nonoperative measures, and an
abdominal abscess in another two patients (one was treated by laparoscopic drainage and the other by
laparotomy). Early adhesive obstruction developed in two cases and was removed laparoscopically. Fatal outcomes and complications connected with laparoscopy were not encountered.