Comparison of Transumbilical Laparoscopically Assisted Appendectomy to Conventional Laparoscopic Appendectomy in Children

Karam, Paul A.; Mohan, Arathi; Buta, Martin; Seifarth, Federico G.

doi:10.1097/sle.0000000000000334

Cited by 10 publications

(9 citation statements)

References 11 publications

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“…Karam et al conducted a retrospective study with the aim to compare surgical outcomes of children with AA treated with the transumbilical laparoscopically assisted appendectomy (TULAA) versus the CLA and showed that TULAA had a shorter operative time (median, 40 vs 67 min; P < 0.001), a shorter length of stay (median, 20 vs 23 h; P < 0.001), and lower costs (median $6266 vs $8927; P < 0.001), even if SSI rate was slightly higher in the TULAA group (6% vs 4%; P = 0.19) [148].…”

Section: Q44: Does Laparoscopic Single-incision Surgery Confer Any mentioning

confidence: 97%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Section: Q44: Does Laparoscopic Single-incision Surgery Confer Any mentioning

confidence: 97%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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“…TULAA combines the advantages of the favorable intra-abdominal visualization of laparoscopy and the safety and speed of traditional extracorporeal open appendectomy [26]. A few recent reports using TULAA in children showed a significantly shorter operative time than with MLA [18,19,20,21].…”

Section: Discussionmentioning

confidence: 99%

“…The transumbilical excision is technically easier in children than in adults because the distance between the umbilicus and the cecum is shorter in children than in adults, with a more flexible abdominal wall than in adults, facilitating exteriorization of the appendix through the umbilicus [28,29]. Most pediatric studies simply exteriorized the appendix through the umbilicus without dissection of the peritoneal attachments of the appendix and the cecum [15,16,19,21,28,29], although a few studies dissected the peritoneal attachments in some children when needed [17,18,20]. We routinely dissected the peritoneal attachments of the appendix and the cecum in adults in order to exteriorize the appendix easily through the transumbilical incision.…”

Section: Discussionmentioning

confidence: 99%

“…A few pediatric surgeons have attempted ‘extracorporeal’ resection of the appendix via single umbilical incision and have usually called it transumbilical single-incision laparoscopic assisted appendectomy (TULAA) [13,14,15,16,17]. Recent studies about TULAA show a shorter operative time than for conventional MLA [18,19,20,21]. We introduced a similar surgical technique for adults and young adolescents with a few modifications.…”

Section: Introductionmentioning

confidence: 99%

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Transumbilical Single-Incision Laparoscopic-Assisted Appendectomy (TULAA) is Useful in Adults and Young Adolescents: Comparison with Multi-Port Laparoscopic Appendectomy

et al. 2019

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Background and objectives: Single-port laparoscopic appendectomy (SLA) in most previous studies has used intracorporeal excision of the appendix and needed a longer operative time than multi-port laparoscopic appendectomy (MLA), although SLA does have the potential benefit of an almost invisible scar within the umbilicus. Some studies have reported that extracorporeal transumbilical single-incision laparoscopic-assisted appendectomy (TULAA) in children took a considerably reduced operative time compared to MLA. We adopted TULAA in adults, adding routine dissection of the peritoneal attachment of the appendix. The aim was to compare the operative outcomes between TULAA and MLA. Materials and Methods: Between March 2013 and January 2016, 770 patients with acute uncomplicated and complicated appendicitis from 15 to 75 years of age were enrolled retrospectively. The operation was performed as early (EA) and interval appendectomy (IA). Results: Operative time was shorter in the TULAA group than in the MLA group, except for IA. No open conversion occurred in the TULAA group, except one case of ileocecal resection for IA. No intra-abdominal fluid collection was found in the TULAA group. Extended resection (especially partial cecectomy) was performed less frequently in the TULAA group than in the MLA group for IA. Mean postoperative hospital stay was shorter in the TULAA group for uncomplicated appendicitis. When the data of the EA group and the IA group were compared, operative time was significantly shorter in the IA group for both MLA and TULAA. The open conversion rate and the complication rate tended to be lower in the IA group. Confined to IA, the TULAA group tended to have shorter mean initial, postoperative, and total hospital stays. Conclusions: TULAA can be a useful surgical alternative to MLA in adults and young adolescents, because it lacks open conversion and provides both a shorter operative time and a shorter postoperative hospital stay. TULAA is feasible for IA in that it showed a lower rate of extended resection and complications.

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“…The decision to operate or not to operate on these patients should remain in the hands of the consulted surgeon; however, this decision may be made in the future by ER physicians, and surgery is challenged by the alternative of avoiding a procedure at all. LA certainly offers a better choice for patients when compared to open appendectomy, but there are several options to improve the standard operative technique aiming for a less invasive procedure including mini-incision and hybrid appendectomy [22, 23]. SILS, NOTES, and robotic assisted appendectomy have been shown to be feasible but are not universally available, increase costs, and do not make incisions smaller [11, 14, 24].…”

Section: Discussionmentioning

confidence: 99%

Development of a Two Port Laparoscopic Appendectomy Technique at a Rural Hospital

Bonatti

2019

Minimally Invasive Surgery

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Background. Laparoscopic appendectomy (LA) is most commonly performed using two 5-mm and one 10/12-mm ports. Various attempts to reduce the number and size of ports have been made and new technologies such as single port LA have been introduced. Appendix and mesoappendix are usually divided with a stapler or energy device with electrocautery, clips, and endoloop being cheaper options. Patients and Methods. This study includes 51 consecutive LAs performed at a rural hospital. Patients were divided into 4 groups: group 1 was the standard technique group (n=12), group 2 served as a “try-out” (n=12), group 3 served as feasibility group (n=12), and group 4 was the final patient cohort in which the optimized technique was preferably used (n=15). Results. Median age of the study cohort was 35.4 (range: 6.2-80.6) years, and 55% of patients were male. Whereas in G1 all patients had standard port placement (10/12-mm, 2x5-mm), in an increasing number of patients in G2-4 only two 5-mm ports and the 2.3-mm Teleflex minigrasper were inserted. Usage of staplers and/or energy devices was reduced from 100% in G1 to 20% in G4, and in the majority of cases both the appendix and the vascular pedicle were secured with an endoloop. The new technique did not add time to the procedure or total OR time. No stump-leaks or surgical site infections were encountered in this series, and there were no conversions to open surgery. Cost savings when not using a stapler or energy device are approximately 400$ per case; the minigrasper added approximately 200$ to the case. Discussion. LA with use of two ports and a portless needle grasper is feasible in the majority of cases and was associated with high patient satisfaction and excellent cosmetic results. Avoiding energy devices and staplers is cost saving; the endoloop securely controls appendix and mesoappendix.

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Comparison of Transumbilical Laparoscopically Assisted Appendectomy to Conventional Laparoscopic Appendectomy in Children

Abstract: TULAA had a shorter OT and was less costly than conventional TPLA. TULAA should be considered as the first surgical approach at treating appendicitis in children.

Cited by 10 publications

References 11 publications

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Transumbilical Single-Incision Laparoscopic-Assisted Appendectomy (TULAA) is Useful in Adults and Young Adolescents: Comparison with Multi-Port Laparoscopic Appendectomy

Development of a Two Port Laparoscopic Appendectomy Technique at a Rural Hospital

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