Laparoscopic appendectomy is associated with lower morbidity in extremely obese children.

PURPOSE: In recent years there has been worldwide increase in childhood obesity. However, in the beginning laparoscopic appendectomy in obese children was contraindicated, now it is commonly used for the treatment of appendicitis. The purpose of this study was to compare open versus laparoscopic appendectomy in extremely obese children. METHODS: The hospital records of 1,383 consecutive patients, who underwent appendectomy for acute appendicitis between 2000 and 2009 were analyzed. 238 children (17.2%) were extremely obese. Extremely obese was defined, as greater than 2 standard deviations above the standardized mean weight for age. 61 of 238 (25.6%) patients had open appendectomy and 177 (74.3%) underwent laparoscopic appendectomy. The length of hospital stay, operation time, complication rate and frequency of taking postoperative pain relief were compared between open and laparoscopic appendectomy in extremely obese children. RESULTS: The incidence of complicated and non-complicated appendicitis was similar both in open and laparoscopic appendectomy group. Laparoscopic appendectomy for acute appendicitis in extremely obese children is associated with significantly shorter operating time (46.8 vs. 59.87 min, P < 0.05), lower overall complication rate (5 vs. 8.2%, P < 0.05) and lesser postoperative analgesia requirement (6.97× vs. 4.73×, P < 0.05). CONCLUSION: Laparoscopic appendectomy should be the procedure of choice for the treatment of acute appendicitis in extremely obese children.

Increased incidence of negative appendectomy in childhood obesity.

BACKGROUND: In recent years, there has been worldwide increase in childhood obesity. The diagnosis of acute appendicitis in very obese children can sometimes be difficult and challenging. The purpose of this study was to determine the incidence of histologically normal appendix in very obese and non-obese children undergoing emergency appendectomy for the clinical diagnosis of acute appendicitis. METHODS: The hospital records of 1,228 consecutive patients, who underwent appendectomy for acute appendicitis between 2000 and 2008, were analyzed. 207 children (16.9%) were very obese. Very obese was defined as greater than 2 standard deviations above the standardized mean weight for age. Histological data was compared between very obese and non-obese children. Seventy-seven (37%) of 207 very obese and 398 (39%) of 1,021 non-obese children had ultrasound preoperatively. RESULTS: The incidence of normal appendectomy was significantly higher in very obese children compared to non-obese children (24.6 vs. 9.9%, P < 0.001). The false positive rate of ultrasound was significantly higher in very obese children group compared to non-obese (26 vs. 6%, P < 0.05). The specificity, sensitivity, positive and negative predictive values of ultrasound were significantly lower (P < 0.05) in very obese children group compared to non-obese children. CONCLUSION: Suspected appendicitis in childhood obesity is associated with increased incidence of normal appendectomy. Active observation in hospital in very obese children may reduce the rate of normal appendectomy without increasing the incidence of complicated appendicitis.

Is C-reactive protein a reliable test for suspected appendicitis in extremely obese children?

PURPOSE: The diagnosis of acute appendicitis by physical examination can sometimes be difficult in extremely obese children. C-reactive protein (CRP) is commonly used to support the clinical diagnosis of appendicitis. However, obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators including CRP. The aim of this study was to examine the association between obesity and CRP levels in extremely obese children presenting with suspected appendicitis. MATERIALS: The hospital records of 947 consecutive patients, who underwent appendectomy for acute appendicitis between 2002 and 2008 were retrospectively analyzed. 164 children (17.3%) were extremely obese. Extreme obesity was defined, as greater than two standard deviations above the standardized mean weight for age. The diagnostic value of CRP level was compared between extremely obese and non-obese children. RESULTS: The incidence of histologically normal appendix was significantly higher in extremely obese children [42 out of 164 (25.6%)] compared to non-obese children [85 out of 783 (10.8%) (P < 0.001)]. The mean CRP levels were significantly higher in extremely obese children with histologically normal appendix compared to non-obese children with normal appendix (P < 0.001). The specificity and the positive predictive value were significantly lower in the extremely obese children group than in the non-obese group (P < 0.001). CONCLUSION: CRP is not a reliable marker of inflammation in extremely obese children presenting with suspected appendicitis. Our data highlight the importance of obesity when interpreting the significance of an elevated CRP level in children with suspected diagnosis of appendicitis.