Transumbilical Laparo-Assisted Appendectomy: A Safe Operation for the Whole Spectrum of Appendicitis in Children—A Single-Centre Experience

The paper reports the results of a retrospective review of the medical charts of 203 patients admitted to a pediatric surgical unit with a diagnosis of acute appendicitis between January 2006 and December 2010 when a transumbilical laparoscopic-assisted appendectomy (TULAA) was introduced as a new surgical technique. Among 203 admitted patients, 7 (3.5%) had a localized appendiceal abscess and were treated with antibiotics. All of them responded to antibiotics and underwent TULAA interval appendectomy 8 weeks later. 196 patients (96.5%) underwent immediate surgery. In 12/181 (6.6%) urgent cases, conversion to laparotomy was necessary, in 3 patients because of bowel distension and in 9 for retrocecal position of appendix. In all 181 TULAA completed procedures, one trocar was used in 151 cases (89.4%), two trocars in 16 (9.4%), and three trocars in 2 (1.2%). The mean operative time for single port TULAA was 52′ Complications included 5 wound infections and 5 intra-abdominal abscesses, all managed conservatively. In conclusion, TULAA is a safe, minimally invasive approach with acute appendicitis, regardless of the perforation status, and can be recommended in the pediatric urgical settings. 1. Introduction Appendicitis is the most frequent indication for urgent surgery in children. Since 1894, when Mc Burney described the laparotomic technique for appendectomy, the same operation has been the gold standard for acute appendicitis for over a century. In 1983, Semm [1] described for the first time the standard three ports laparoscopic appendectomy and since then the minimally invasive approach has gained wide acceptance among the pediatric surgeons. Different variations of the laparoscopic technique have been proposed, all aiming to better cosmetic results, reduction in costs, and charges for hospitals, while keeping the safety of the operation unchanged. The umbilicus as the unique site to gain access to the abdomen and to the appendix has been widely reported in the literature, both as a port to exteriorize the appendix and perform an extracorporeal operation [2, 3] and as the site to place all laparoscopic instruments and perform an intracorporeal appendectomy (SILS; single-site laparoscopic surgery) [4, 5]. The trans umbilical laparo-assisted technique (TULAA) merges together the advantages of both a good intraabdominal laparoscopic visualization and the safety and quickness of an extracorporeal traditional appendectomy. A large series of pediatric patients operated on with this technique was presented in 1999 by Valla et al. [2], but patients were