OBJECTIVE: To explore the experience of laparoscopic-assisted pediatric appendectomy. METHODS: We retrospectively analyzed the case data of 31 children who underwent laparoscopic-assisted appendectomy in our hospital from May 2009 to September 2011. RESULTS: All 31 children completed the operation successfully, and none of them had an intermediate open abdomen. Postoperatively, three cases developed right lower abdominal McIlroy’s point incision infection and four cases developed abdominal residual abscess. Conclusion:Laparoscopic-assisted pediatric appendectomy is less invasive, less complications, faster postoperative recovery, and simpler than open surgery. Acute appendicitis is the most common acute abdominal condition in pediatric surgery, accounting for about 1/4 of all pediatric surgical emergencies, and appendectomy is the main means of treatment. Since the first laparoscopic appendectomy (LA) performed by Prof. Semm, a German obstetrician and gynecologist, in 1983, the LA technique has rapidly emerged in China and has been widely promoted in the field of pediatric surgery. From May 2009 to September 2011, 31 cases of laparoscopic assisted appendectomy were performed in our hospital with satisfactory results. The consultation and treatment data are summarized as follows. 1. Data and methods 1.1 Clinical data: 31 cases of laparoscopic-assisted appendectomy were selected in our hospital from May 2009 to September 2011, 21 males and 10 females, aged 3-14 years old, with an average age of 7.6 years. They included 4 cases of chronic appendicitis, 5 cases of acute simple appendicitis, 16 cases of acute suppurative appendicitis, and 6 cases of acute gangrenous appendicitis. All cases were operated after diagnosis and confirmed by pathological examination after surgery. 1.2 Surgical method: Preoperative urinary evacuation, anesthesia was performed by tracheal intubation and static suction compound anesthesia. A small incision of about 0.5 cm was made at the inferior edge of the umbilical port, and the layers of the abdominal wall were incised sequentially to enter the abdominal cavity. Then a 5mm Trocar was placed, CO2 pneumoperitoneum with 10mmHg air pressure, and the laparoscopic probe was inserted. If the appendicitis is severe and the adhesions to the surrounding tissues are obvious, a 5mm Trocar is placed next to the left rectus abdominis muscle in the flat umbilicus as a secondary operation hole. The small intestine is pushed medially with atraumatic grasping forceps to find the cecum, and the appendix is found by probing along the colonic band toward the tip of the cecum, separating the appendix from the surrounding tissue adhesions, holding the end of the appendix with spring forceps, raising it from the right McKay’s point, deflating the abdominal cavity, and severing and ligating the appendiceal mesentery to the root of the appendix outside the body. The appendix was ligated and severed at 0.5 cm from the root of the appendix, and the appendiceal stump was treated with three rods. The pus in the abdominal cavity was aspirated with suction and drainage tubes were placed to drain the cavity if necessary. If there was no active bleeding, the Trocar was removed and the incision was sutured and bandaged. 2. Results All 31 children completed the operation successfully, and there was no case of open abdomen. 4 cases of septic and gangrenous appendicitis were left with abdominal drains, which were removed on the third day after the operation. The operating time was 25-150 minutes, and no postoperative abdominal bleeding, intestinal fistula or adhesive intestinal obstruction occurred. After 12-24 hours of postoperative ventilation, feeding was started. All children in this group were examined pathologically after surgery and were consistent with the clinical diagnosis. There were 7 cases of postoperative complications, including 3 cases of right lower abdominal McInnis point incision infection, which were cured by changing medicine and wet dressing with alcohol; 4 cases of postoperative abdominal cavity residual abscess, which were treated with external Chinese medicine (rhubarb and mannitol) and strengthened anti-infection treatment, and all were cured and discharged. In the 1970s, Gans applied laparoscopy to diagnose biliary atresia and gonadal insufficiency, which marked the beginning of pediatric laparoscopic surgery. 1981, Gans visited China and introduced pediatric surgical laparoscopic techniques, and since then, pediatric laparoscopic techniques have rapidly emerged in China. The application of laparoscopic technology has brought about fundamental changes in minimally invasive surgery, which has changed the traditional view of treatment and surgical approach, especially in the etiology of unexplained abdominal pain and intestinal obstruction, which has important application value. Laparoscopic surgery is less traumatic, with fewer complications, quicker recovery, less obvious postoperative scars and less impact on the psychological and physiological development of the child, thus representing the future development direction of pediatric surgery. Laparoscopic-assisted appendectomy has many advantages compared with traditional open surgery. (1) Since laparoscopy-assisted appendectomy does not require incision of all layers of the abdominal wall, there is no obvious damage to the abdominal wall muscles, less intestinal damage during surgery, less surgical trauma, low incidence of postoperative incision infection, subcutaneous fat liquefaction and adhesive intestinal obstruction, and fast recovery. CRP is a sensitive index reflecting the degree of tissue damage, and its level is positively correlated with the severity of trauma of the body. The findings of Li Yingchao et al. showed that the level of CRP continued to decrease at 24 and 72 h after LA, while it increased and then decreased after open surgery, and this change of CRP objectively reflected the minimally invasive nature of the organism. (2) Traditional open surgery has a small surgical field, especially for obese and ectopic appendix children, and it is very difficult to find the appendix, sometimes even requiring an extended surgical incision. A huge advantage of laparoscopic surgery is the wide field of view, which is not affected by the location of the appendix and the thickness of the abdominal wall, making it relatively easy to find the appendix, greatly reducing the operation time and causing little blow to the organism. Under direct laparoscopic view, septic and gangrenous, perforated appendicitis aspiration of abdominal pus is convenient and thorough, which greatly reduces the occurrence of postoperative abdominal residual abscess and adhesive intestinal obstruction; for some children with serious conditions requiring placement of abdominal drainage tubes, the best drainage site can be selected under direct view. (3) Laparoscopy has both diagnostic and therapeutic value. Laparoscopy can comprehensively explore the abdominal and pelvic cavities to observe whether there are combined other lesions, such as Michael’s diverticulum, sphingomyelia, ovarian cysts. 2 cases of combined sphingomyelia were found in our group and were treated simultaneously with good results. It avoided the blow of re-operation and reduced the pain of the children and the economic burden of the parents. Therefore, for children with appendicitis with doubtful preoperative diagnosis, laparoscopy can be used for accurate diagnosis and corresponding treatment to achieve intraoperative diagnosis and treatment integration. Laparoscopic-assisted appendectomy, in which the appendix is raised and removed outside the abdominal cavity, is a laparoscopic-assisted technique. Compared with laparoscopic appendectomy, there is no need for intra-abdominal suturing and knotting, and the operation is relatively simple, i.e., time-saving and labor-saving, which is especially suitable for laparoscopic beginners. The appendix is raised outside the body for tethered dissection with the assistance of laparoscopy, the ligation of the appendicular artery is more reliable, the operation is safer, and the possibility of postoperative abdominal bleeding is smaller. However, there is also a big problem that the appendix is raised directly out of the poke hole, which is prone to poke hole infection, especially septic and gangrenous perforated appendicitis, and three children in our group had poke hole infection after surgery. The laparoscopic treatment of appendicitis carried out in recent years has been recognized by the majority of pediatric surgeons and parents of children due to various advantages. However, because laparoscopic appendectomy requires tracheal intubation, static suction compound general anesthesia, carbon dioxide pneumoperitoneum has certain effects on the cardiovascular and respiratory systems of children, and the operation cost is high, so it still cannot completely replace the traditional open surgery. It is believed that with the continuous progress of laparoscopic technology and the improvement of economic level, laparoscopic treatment of pediatric appendicitis will definitely become the preferred option for appendicitis treatment.