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Single-center comparison of outcomes between laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy

      Highlights

      • What is currently known about this topic?
        • 1.
          Current research has mixed results when comparing laparoscopic appendectomy to TULAA, with very few studies comparing the two surgical techniques.
      • What new information is contained in this article?
        • 2.
          TULAA is an equally safe surgical technique to treat pediatric appendicitis when compared to laparoscopic appendectomy.

      Summary

      Purpose

      Appendectomy is the most common pediatric emergency surgery performed to date. This study compared outcomes between laparoscopic appendectomy (LA) and transumbilical laparoscopic assisted appendectomy (TULAA) for 1154 uncomplicated patients across 5 years at a single institution. Primary outcomes include length of stay (LOS), post-operative complications, pain score, and operating room (OR) time.

      Methods

      Demographic and clinical data was collected for 1154 eligible patients treated for uncomplicated appendicitis between August 2014-October 2019, with 830 patients in the LA group, and 324 in the TULAA group. Mixed effects modeling procedure using logistic and linear regression examined the effect of surgery type on the four primary outcomes after adjustment for potential clustering effect of surgeon and confounding factors.

      Results

      Of 1154 patients, 62.7% were male, and mean (SD) age was 10.9 (3.6) years. Median [IQR] LOS was 28.0 hours [22.0, 36.0], mean (SD) OR time was 29.0 (10.0) minutes, and median [IQR] pain at maximum level was 5.5 (2.7). The complication rate overall was <5.0% and did not differ between TULAA and LA groups (p>.05). OR time was reduced by an average of 5.2 minutes in the TULAA group (p<.001), pain did not differ between groups overall (p>.05), and patients were more likely to be discharged within 24 hours in patients who underwent TULAA (OR=5.3 [1.6, 17.4], p=.007).

      Conclusion

      Retrospective analysis of 1154 pediatric appendectomies, found no difference in complications between single- and three-incision laparoscopic procedures (TULAA vs. LA). Findings suggest TULAA is a safe procedure for acute appendicitis in pediatrics.

      Keywords

      Abbreviations:

      LA (Laparoscopic appendectomy), OA (Open appendectomy), SILA (Single-incision laparoscopic appendectomy), TULAA (Transumbilical laparoscopic assisted appendectomy)
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      References

      1. Cleveland Clinic. Appendicitis in Kids: Symptoms, Treatment & Recovery, https://my.clevelandclinic.org/health/diseases/10792-appendicitis-in-children#:∼:text=Appendicitis%20affects%2070%2C000%20children%20per,emergency%20abdominal%20surgery%20in%20childhood; 2021 [accessed February 10, 2022]

        • Markar S.R.
        • Karthikesalingam A.
        • Di Franco F.
        • et al.
        Systematic review and meta-analysis of single-incision versus conventional multiport appendicectomy.
        Br J Surg. 2013; 100: 1709-1718https://doi.org/10.1002/bjs.9296
        • Semm K.
        Endoscopic appendectomy.
        Endoscopy. 1983 Mar; 15 (. PMID:6221925): 59-64https://doi.org/10.1055/s-2007-1021466
        • Hernández-Cortez J.
        • De León-Rendón J.L.
        • Martínez-Luna M.S.
        • et al.
        Acute appendicitis: literature review.
        Cirujano General. 2019; 41: 33-38
        • Perin G.
        • Scarpa M.G.
        TULAA: A Minimally Invasive Appendicectomy Technique for the Paediatric Patient.
        Minim Invasive Surg. 2016; 2016 (Epub 2016 Dec 18. PMID: 28078139; PMCID: PMC5203905)6132741https://doi.org/10.1155/2016/6132741
        • Trutschel D.
        • Palm R.
        • Holle B.
        • et al.
        Methodological approaches in analysing observational data: a practical example on how to address clustering and selection bias.
        International Journal of Nursing Studies. 2017; 76: 36-44
        • Bergholz R.
        • Krebs T.F.
        • Klein I.
        • et al.
        Transumbilical laparoscopic-assisted versus 3-portlaparoscopic and open appendectomy: a case-control study in children.
        Surg Laparosc Endosc Percutan Tech. 2014; 24: 244-247https://doi.org/10.1097/SLE.0b013e31828f6c16
        • Stanfill A.B.
        • Matilsky D.K.
        • Kalvakuri K.
        • et al.
        Transumbilical laparoscopically assisted appendectomy: an alternative minimally invasive technique in pediatric patients.
        J Laparoendosc Adv Surg Tech A. 2010; 20: 873-876https://doi.org/10.1089/lap.2010.0147
        • Jaschinski T.
        • Mosch C.G.
        • Eikermann M.
        • Neugebauer E.A.
        • Sauerland S.
        Laparoscopic versus open surgery for suspected appendicitis.
        Cochrane Database Syst Rev. 2018; 11 (PMID: 30484855; PMCID: PMC6517145): CD001546https://doi.org/10.1002/14651858.CD001546.pub4
        • Nicholson T.
        • Tiruchelvam V.
        Comparison of laparoscopic-assisted appendectomy with intracorporal laparoscopic appendectomy and open appendectomy.
        JSLS. 2001 Jan-Mar; 5 (PMID: 11303994; PMCID: PMC301541): 47-51
        • Ostlie D.J.
        Single-site umbilical laparoscopic appendectomy.
        Semin Pediatr Surg. 2011; 20: 196-200https://doi.org/10.1053/J.SEMPEDSURG.2011.05.003
        • Scirè G.
        • Mariotto A.
        • Peretti M.
        • et al.
        Laparoscopic versus open appendectomy in the management of acute appendicitis in children: a multicenter retrospective study.
        Minerva Pediatr. 2014; 66: 281-285
        • Kulaylat A.N.
        • Podany A.B.
        • Hollenbeak C.S.
        • et al.
        Transumbilical laparoscopic-assisted appendectomy is associated with lower costs compared to multiport laparoscopic appendectomy.
        J Pediatr Surg. 2014; 49: 1508-1512https://doi.org/10.1016/j.jpedsurg.2014.03.016
        • Chang P.C.
        • Lin S.C.
        • Duh Y.C.
        • et al.
        Should single-incision laparoscopic appendectomy be the new standard for pediatric appendicitis?.
        Pediatrics & Neonatology. 2020; 61: 426-431https://doi.org/10.1016/j.pedneo.2020.03.013
      2. Visnjic S. Transumbilical laparoscopically assisted appendectomy in children: high-tech low-budget surgery. Surgical endoscopy, 22(7), 1667–1671. https://doi.org/10.1007/s00464-007-9680-3.

        • Aly O.E.
        • Black D.H.
        • Rehman H.
        • et al.
        Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: A systematic review and meta-analysis.
        Int J Surg. 2016; 35: 120-128https://doi.org/10.1016/j.ijsu.2016.09.087
        • Khan S.Y.
        • Al-Balushi Z.N.
        • Bhatti K.M.
        • et al.
        Cost Comparison between Laparoscopic and Open Appendectomies in Children.
        Sultan Qaboos Univ Med J. 2013; 13 (Epub 2013 May 9. PMID: 23862034; PMCID: PMC3706118): 275-279https://doi.org/10.12816/0003234
        • Ruiz-Patiño A.
        • Rey S.
        • Molina G.
        • et al.
        Cost-effectiveness of laparoscopic versus open appendectomy in developing nations: a Colombian analysis.
        J Surg Res. 2018 Apr; 224 (Epub 2017 Dec 22. PMID: 2950684): 33-37https://doi.org/10.1016/j.jss.2017.11.007