ADVANCED SURGICAL TECHNIQUES IN SUPPULAR APPENDICITIS IN PEDIATRIC PATIENTS: CLINICAL MANAGEMENT OF MINIMALLY INVASIVE APPROACHES

Abstract

Acute appendicitis is one of the most common abdominal emergencies in childhood. Surgery, traditionally performed by laparotomy, has evolved with the introduction of minimally invasive techniques, such as laparoscopy. These approaches offer benefits such as less surgical trauma, shorter recovery time and better aesthetic results. However, suppurative appendicitis, characterized by the presence of pus in the appendix, represents an additional challenge for the pediatric surgeon, requiring careful management and the choice of the most appropriate surgical technique. Objective: The objective of this systematic literature review was to evaluate the effectiveness and the safety of minimally invasive surgical techniques in the treatment of suppurative appendicitis in pediatric patients. Methodology: The systematic review was conducted following the PRISMA checklist criteria. The PubMed, Scielo and Web of Science databases were used to search for articles published in the last 10 years. The descriptors used were: "appendicitis", "children", "laparoscopy", "minimally invasive surgery" and "suppurative appendicitis". The inclusion criteria were: original studies, pediatric patients, diagnosis of suppurative appendicitis and comparison between laparoscopy and laparotomy. Exclusion criteria were: reviews, meta-analyses, case studies, adult patients and non-suppurative appendicitis. Results: The search resulted in a significant number of articles, which were analyzed according to the inclusion and exclusion criteria. The results indicated that laparoscopy is a safe and effective technique in the treatment of suppurative appendicitis in children, with a shorter hospital stay, less postoperative pain and a lower incidence of complications compared to laparotomy. However, conversion to laparotomy may be necessary in some cases, especially in patients with perforated appendicitis or diffuse peritonitis. Conclusion: Minimally invasive surgical techniques, especially laparoscopy, represent a significant advance in the treatment of suppurative appendicitis in pediatric patients. The benefits of these approaches include less surgical trauma, shorter recovery time, and better aesthetic results. However, the choice of surgical technique must be individualized, taking into account the patient's characteristics and the severity of the disease. Conversion to laparotomy may be necessary in some cases, but laparoscopy remains the technique of choice for most patients.