Outcomes of laparoscopic versus open appendectomy in children with complex appendicitis without appendiceal mass and/or abscess: a subgroup analysis from a multicentre prospective cohort study (CAPP study)
In brief
Complications affected 14% after laparoscopic and 15% after open appendectomy
In a prospective study of 989 children with complex appendicitis without an abscess or mass, complications within three months occurred in 14.4% after laparoscopic surgery and 15.2% after open surgery, with no significant difference. Other measured outcomes were similar, while open surgery cost less; however, only 46 children had open surgery, limiting the comparison.
- Journal
- Surgical endoscopy (Q1)
- Published
- 6 November 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Paul van Amstel, Said Bachiri, Rik van Eekelen, Marijke C van der Weide, Hester Rippen-Wagner, Taco S Bijlsma, et al.
- PMID
- 42993280
- DOI
- 10.1007/s00464-026-13454-5
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 7 November 2026): Multicentre comparison of appendectomy approaches in children
Abstract
BACKGROUND: Although appendectomy is widely accepted as the standard of treatment in children with complex appendicitis without appendiceal mass and/or abscess, discussion remains on the optimal surgical approach. In this group, we aimed to compare outcomes of laparoscopic appendectomy (LA) with open appendectomy (OA). METHODS: A multicentre, prospective cohort study was conducted in children (< 18 years old) with preoperative suspicion of complex appendicitis without appendiceal mass and/or abscess. The primary outcome was the proportion of participants experiencing postoperative complications within 3 months. Secondary outcomes included hospitalization, unscheduled healthcare visits, disability days, parental work absence, health-related quality of life (Hr-QoL), patient satisfaction, and healthcare costs. Propensity analysis was performed to adjust for baseline differences and selection bias. RESULTS: In total, 1308 children were enrolled across 38 Dutch hospitals, nine were excluded from analysis leaving a total of 1299. Of these, 989 (76.1%) met criteria for complex appendicitis without appendiceal mass and/or abscess. LA was performed in 943/989 (95.3%) and OA was performed in 46/989 (4.7%) of participants. The complication rate within 3 months was not statistically significantly different between LA (14.4%) and OA (15.2%) (weighted OR 0.68, 95 %CI 0.17 to 1.87), nor was there any difference in severity. The medical costs in the OA group were significantly lower than the LA group (mean difference= €- 868, - 95 CI - 1400 to - 337). No differences were observed in hospitalization, unscheduled healthcare visits, disability days, parental work absence, Hr-QoL, and patient satisfaction. CONCLUSIONS: In this study, majority of children with complex appendicitis without appendiceal mass and/or abscess were managed by LA which limits comparability. Similar outcomes between LA and OA were observed in terms of complications, hospitalization, unscheduled healthcare visits, disability days, parental work absence, Hr-QoL, and patient satisfaction after 3 months. Medical costs were significantly lower in the OA group, presumably due to higher costs accompanied with laparoscopy. TRIAL REGISTRY: NCT04755179; NL9371.
Abstract as published, via PubMed.
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