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

Abstract

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.

Cirugía transumbilical asistida versus multipuerto en pacientes pediátricos con diagnóstico de apendicitis aguda

“…Al revisar la literatura sobre estas dos técnicas quirúrgicas, se encuentra que hay menor costo y complicaciones con LTA 5,6 , por lo que el objetivo de nuestro estudio fue comparar los dos grupos de pacientes pediátricos con diagnostico de apen-el rango de edad más común fue entre los 11 y 16 años, con una media de 10,3 y una mediana de 11 (Tabla 1). En 528 (62,1 %) pacientes se empleó la técnica LMP y en 322 (37,9 %) pacientes la técnica LTA.…”

“…En la literatura se sugiere que LTA es superior a LMP para el manejo de los pacientes con apendicitis aguda en cuanto a costos, complicaciones y disminución del tiempo operatorio [5][6][7] . En niños está patología quirúrgica y sus desenlaces postoperatorios son de gran importancia ya que es la urgencia más frecuente 8 , por lo que el estudio de su manejo en este grupo etario es indispensable para el sistema de salud.…”

Impact of single-port laparoscopic approach on postoperative pain and cosmesis for acute appendicitis: a comparison with multi-port laparoscopic approach

“…These results can be deduced form the fact that in amed appendix may contaminate the wound which may cause infection in open appendectomy. In studies comparing SPLA and MPLA, Peter et al in their prospective randomized trial reported that wound infection was 3.3% in the single-incision group and 1.7% in the 3-port group, respectively, without statistically signi cant difference, and SG Jin et al reported 8.7% of wound complication in single-port method compared to 5.6% of conventional method [14,23]. A meta-analysis demonstrated that SSI rate was similar between SPLA and MPLA [29].…”

“…These concepts have led to the development of single-port laparoscopic surgery for various kinds of diseases [6][7][8][9][10]. Single-port laparoscopic appendectomy (SPLA) was rstly introduced by Esposito in 1998 and has been suggested potential advantages including better cosmetic outcome, less postoperative pain, and avoidance of possible hemorrhagic complications from injuring epigastric vessels [11][12][13][14].…”

Single-Port Laparoscopic Appendectomy Performing by Emergency Operation: An Intervention Study in Vietnam

“…In addition, SPLA has been studied in many countries with different types of patients, from adults to children, with desirable results (9). Besides, SPLA has been studied in many countries with different patients, from adults to children, with desirable results (10)(11)(12).…”