Transumbilical laparoscopically assisted extracorporeal appendectomy in children and young adults: A retrospective cohort study

Abstract

SP has comparable surgical outcomes in adolescent, adult, and pediatric patients.

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

“…Technical difficulty might explain the longer operative time during the intracorporeal excision of the appendix in SLA. In pediatric surgery, a few studies were on the removal of the appendix through a single umbilical incision and extracorporeal excision [13,14,15,16,17]. TULAA combines the advantages of the favorable intra-abdominal visualization of laparoscopy and the safety and speed of traditional extracorporeal open appendectomy [26].…”

“…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.…”

“…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].…”

Update on Transumbilical Single-Incision Laparoscopic Assisted Appendectomy (TULAA) – Which Children Benefit and What are the Complications?

“…Laparoscopic appendectomy has almost replaced open appendectomy because of reduced abdominal scarring, less postoperative pain, and earlier recovery [14]. Attempts to further reduce the number of incisions resulted in the development of single-incision appendectomy techniques [9][10][11] Most of the techniques skeletonize and separate the appendix intracorporeally. However, problems caused by these techniques are increased costs because of insertion of single-use endoscopic equipment such as retrieval bags, stapler devices or endoloops [15].…”

“…For that reason, TULAA could be the most appropriate minimally invasive technique for appendectomies in children. However, some publications limit the use of TULAA for uncomplicated appendicitis [10,17,19] while other publications report its use in advanced cases [4,9,13].…”