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Research Article|Articles in Press

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

Published:January 19, 2023DOI:https://doi.org/10.1016/j.jpedsurg.2023.01.033
Single-center comparison of outcomes between laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy
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      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]

        View in Article
        • 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
        View in Article
        • Semm K.
        Endoscopic appendectomy.
        Endoscopy. 1983 Mar; 15 (. PMID:6221925): 59-64https://doi.org/10.1055/s-2007-1021466
        View in Article
        • Hernández-Cortez J.
        • De León-Rendón J.L.
        • Martínez-Luna M.S.
        • et al.
        Acute appendicitis: literature review.
        Cirujano General. 2019; 41: 33-38
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • Ostlie D.J.
        Single-site umbilical laparoscopic appendectomy.
        Semin Pediatr Surg. 2011; 20: 196-200https://doi.org/10.1053/J.SEMPEDSURG.2011.05.003
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article

      15. 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.

        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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
        View in Article

      Article info

      Publication history

      Accepted: January 6, 2023
      Received: January 5, 2023

      Publication stage

      In Press Accepted Manuscript

      Identification

      DOI: https://doi.org/10.1016/j.jpedsurg.2023.01.033

      Copyright

      © 2023 Elsevier Inc. All rights reserved.

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