RESULTS OF MINIMALLY INVASIVE VERSUS OPEN APPROACHES IN PEDIATRIC APPENDICITIS: A SYSTEMATIC REVIEW

Introduction: Acute appendicitis is the most common surgical emergency in children and remains a major cause of hospital admission and perioperative morbidity worldwide. Over recent decades, laparoscopic appendectomy has increasingly replaced open appendectomy in pediatric practice, yet uncertainty persists regarding comparative outcomes in uncomplicated and complicated disease. Objective: The primary objective of this systematic review was to compare clinical outcomes of minimally invasive appendectomy versus open appendectomy in pediatric patients with acute appendicitis. Secondary objectives were to evaluate differences in postoperative complication rates, length of hospital stay, operative time, readmission, cost-related outcomes, and patient-centered recovery metrics. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. Comparative studies published within the last five years involving pediatric populations were included. Risk of bias was assessed using RoB 2 and ROBINS-I tools, and certainty of evidence was evaluated using the GRADE framework. Results and Discussion: Twenty comparative studies were included in the final synthesis. Minimally invasive appendectomy was consistently associated with reduced wound infection rates, shorter hospital stay, and improved postoperative recovery metrics compared with open appendectomy. Intra-abdominal abscess rates were generally comparable between approaches, including in complicated appendicitis. Operative time was frequently longer with laparoscopy, but this did not translate into increased morbidity or readmission. Certainty of evidence was moderate for reductions in length of stay and surgical site infection, and low-to-moderate for organ-space infection due to heterogeneity across studies. Conclusion: Contemporary evidence supports laparoscopic appendectomy as the preferred approach in most pediatric appendicitis cases when appropriate expertise is available. Benefits in recovery and wound morbidity appear robust across disease severities, while serious complication rates remain comparable to open surgery. Surgical decision-making should remain individualized, integrating disease severity, institutional capability, and multidisciplinary care pathways.