Feasability of Ambulatory Appendicectomy
Feasability of Ambulatory Appendicectomy
The investigators will conduct a monocentric prospective preliminary study evaluating the
 feasibility of appendectomy for simple acute appendicitis in a cohort of 6-17 year-old
 children presenting to the emergency department of the Hôpital Pédiatrique de Nice CHU-Lenval
 (Lenval Childre Hospital, Nice) on a Period of 1 year.
Acute appendicitis represents the first visceral surgical emergency of the child in terms of
 frequency, resulting in hospitalization, hospitalization and family costs, as well as an
 alteration in family dynamics.

 Reducing the duration of hospitalization and allowing the child to return more quickly to his
 usual environment would not only reduce the risks of nosocomial infections and the workload
 of medical and paramedical teams but would reduce the emotional burden for the child, In
 addition to its consequences in terms of professional disorganization induced in the parents
 by the hospitalization of their child. Ambulatory hospitalization would also reduce the cost
 of this pathology.

 In the context of ambulatory surgery, the patient's journey from admission to hospital must
 be perfectly codified; The novelty of this study lies in the fact of applying this mode of
 hospitalization to emergency surgery.

 Once the consultation for abdominal pain by an emergency pediatrician carried out, the
 diagnostic orientation is confirmed by a visceral pediatric surgeon who performs a biological
 check-up and an abdominal ultrasound. After confirmation of eligibility for ambulatory care
 according to national recommendations and informed consent, the child is - according to the
 time of care and the clinical condition of the patient - immediately hospitalized in the unit
 (UCA) be allowed to return to his home with reconviction in the ambulatory surgery unit the
 next morning, at the opening of the service, on an empty stomach.

 The abdominal ultrasound confirms the orientation and the diagnosis of acute appendicitis
 simple is posed.

 The laparoscopic appendectomy is performed after the anesthesia consultation. The patient is
 monitored and replenished early in the UCA according to a standardized and computerized
 protocol.

 The return home is authorized by the confirmation of "aptitude to the street" by systematic
 consultation of a senior surgeon and an anesthetist.

 The surgical and anesthetic techniques remain the same as in traditional surgery, but the
 timing is organized for an outpatient treatment The follow-up of the child will be carried
 out as early as day 1 by the call of the UCA, then at day 8 during postoperative consultation
 and finally at day 30 post-operative per call.
Inclusion Criteria:

 -  Boy or girl

 -  Subjects aged 6 to 17 years (Children under 6 years of age with a table of acute
 appendicitis will not be included in the high probability of complicated acute
 appendicitis in these young children who are often rapidly changing pathology or
 delayed diagnosis Patients over 17 years of age are usually referred to adult
 hospitals and will not be included)

 -  Surgical indication of appendectomy under laparoscopy for simple acute appendicitis
 according to clinico-biological criteria (Appendix 6).

 -  Ambulatory eligibility according to the criteria usually defined

 -  Dosage of negative bHCG (exclusion of pregnancy)

 -  Parents and children able to understand the study and having signed informed consent

 -  Possibility of organizing childcare immediately at home

 -  Subjects and holders of parental authority who have given their informed and written
 consent

 -  Subjects affiliated to Social Security system

 Exclusion Criteria:

 -  Patients who had spent an overnight stay in hospital prior to surgery and therefore
 could not meet the ambulatory criteria.

 -  An ASA score higher than III

 -  Impossibility of ambulatory surgery due to a residence outside the coverage area
 defined by the surgical and ambulatory anesthesia service, the impossibility of being
 transported after returning home, the absence of parents Child after discharge from
 hospital

 -  Contra-indication to the practice of an appendectomy under laparoscopy