Inflammatory and Molecular Determinants of Disease Severity in Pediatric Acute Abdomen: Implications for Surgical Decision-Making

Abstract

Acute paediatric abdomen is a frequent emergency in paediatric surgery, with acute appendicitis being the most common surgical cause. In recent decades, laparoscopy has progressively displaced laparotomy as the standard approach in hemodynamically stable children, although controversies persist in complex scenarios such as complicated appendicitis or abdominal trauma. This article aims to compare, based on the evidence published in the last five years, the results of surgical management of pediatric acute abdomen using open and laparoscopic techniques, considering indicators of safety, efficacy and postoperative recovery. A narrative review of the literature in biomedical databases was conducted, including observational studies, clinical trials, and systematic reviews on acute appendicitis, abdominal trauma, and other causes of acute abdomen in children under 18 years of age. Recent evidence suggests that laparoscopy is consistently associated with less postoperative pain, reduced hospital stay, and a lower rate of surgical wound infection, with no overall increase in intra-abdominal complications, even in complicated appendicitis, when applied in experienced centers. However, open surgery continues to be necessary in unstable patients, in contexts of limited resources or in contraindications to pneumoperitoneum. It is concluded that laparoscopy should be considered the technique of choice in the management of acute pediatric abdomen in appropriately selected patients, reserving the open approach for specific situations.