Comparison between the use of monopolar diathermy and LigaSure in pediatric laparoscopic appendectomy

Background. Laparoscopic appendectomy (LA) is a widely used technique for the surgical removal of the appendix, offering several advantages over conventional open appendectomy, including less postoperative discomfort, shorter hospital stay, and reduced wound infection rates. Various energy devices have been introduced to enhance surgical safety and efficiency; however, comparative evidence in pediatric populations remains limited. This study aimed to compare the outcomes of LigaSure and monopolar diathermy in pediatric laparoscopic appendectomy, particularly in a resource-limited setting. Method. A prospective observational study was conducted on 32 pediatric patients who underwent laparoscopic appendectomy at Al Zahraa Teaching Hospital in Najaf, Iraq, between January 2022 and April 2023. Patients were divided into two equal groups based on on device availability: LigaSure (n = 16) and monopolar diathermy (n = 16). Exclusion criteria included perforated appendicitis and appendicular masses. Outcomes assessed were operative time, intraoperative bleeding (measured by the number of irrigations), length of hospital stay, port site infection, and readmission. Allocation was non-randomized, and all surgeries were performed by experienced pediatric surgeons. We also looked at port site infections and the switch to open appendectomy. Results. The LigaSure group showed a significantly shorter operative time compared to the monopolar group (35.50 ± 4.31 min vs. 39.88 ± 4.69 min; p = 0.01). No statistically significant differences were observed between the groups in intraoperative bleeding (p = 0.5), length of hospital stay (p = 0.16), port site infection (p = 1.000), or readmission (p = 1.000). In the LigaSure group, 81.2% of patients experienced no intraoperative bleeding, and 93.8% required no readmission, compared with 62.5% and 87.5%, respectively, in the monopolar group. Conclusion. Both LigaSure and monopolar diathermy are safe and effective tools for pediatric laparoscopic appendectomy. LigaSure offers the advantage of a shorter operative time and a tendency toward reduced intraoperative bleeding. However, the small sample size and the subjective bleeding assessment limit the generalizability of these findings. Further randomized controlled studies with larger cohorts are needed to confirm these results.