Transumbilical Laparoscopic-Assisted Appendectomy in the Treatment of Acute Uncomplicated Appendicitis in Children

Abstract

Transumbilical laparoscopic-assisted appendectomy (TULAA) is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis) and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA). All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA) was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males) with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years). Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results).

Acute Uncomplicated Appendicitis and Umbilical Hernia in Children: Open Umbilical Appendectomy an Alternative to the Laparoscopic Approach

“…In our study, two patients had intraoperative bleeding, and hemostasis was done only after conversion in one patient. A study carried out in Italy in 2015 on 300 laparoscopic appendectomies with a trans-umbilical trocar, the authors reported 48 conversion cases including 47 cases that were due to the impossibility of exposure of the appendix and a case of bleeding [12]. In our study, this umbilical approach has also shown its limits in complicated appendicitis, especially in localized or generalized appendicular peritonitis that requires abdominal cavity cleaning.…”

TULAA: A Minimally Invasive Appendicectomy Technique for the Paediatric Patient

“…Koizumi and colleagues [22] excluded patients with evidence of peritonitis. Noviello and colleagues [28], finally, excluded patients affected by complicated appendicitis based on clinical and ultrasound findings: patients affected by complicated appendicitis were treated with open appendicectomy. The heterogeneity of the preoperative protocols adopted in the management of these patients might have influenced the reported surgical outcomes.…”

“…The approach to such condition is extremely different in the reported literature. Valla and colleagues [6], Noviello and colleagues [28], Sesia and colleagues [15], and Varshney and colleagues [12] decided not to consider Transumbilical Laparoscopic Assisted Extracorporeal Appendectomy a feasible technique in the presence of an abscess or appendiceal mass. On the other hand, Codrich and colleagues [21] and Gupta and colleagues [25] decided not to exclude such patients.…”

Apendicectomia aberta versus videolaparoscópica em crianças: estudo prospectivo em hospital público terciário

“…Performed as early as 1880 by Robert Lawson Tait 2 and first described by McBurney in 1894, open appendectomy (OA) has been widely used as a standard in the treatment of appendicitis 3 , as it allows the surgeon to have direct access to the organ 4 . However, it has been replaced by the laparoscopic approach 3 , introduced by Semm in 1983, in which three trocars are used 5 .…”