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Gasless transumbilical laparoscopic-assisted appendectomy as a safe and cost-effective alternative surgical procedure for mild acute appendicitis

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Abstract

Purpose

Several reports have demonstrated the effectiveness and feasibility of single incisional transumbilical laparoscopic-assisted appendectomy (TULAA). We developed a modified TULAA technique, gasless-TULAA, which involves lifting the abdominal wall with a retractor, without pneumoperitoneum or another incision.

Methods

We assessed the surgical outcomes of 257 patients treated for appendicitis in our hospital between 2005 and 2013. In a preoperative comprehensive evaluation, appendicitis without abscess was defined as mild appendicitis (mild appendicitis group: MAG), and appendicitis with abscess was defined as severe appendicitis (severe appendicitis group: SAG). The clinical outcomes were compared with those in other published reports. The cost-effectiveness of gasless-TULAA was compared with that of conventional multiport laparoscopic appendectomy (CMLA) in our hospital.

Results

In MAG (n = 228), the operation time and postoperative hospital stay were 46.9 ± 22.7 min and 2.6 ± 1.2 days, respectively. The gasless-TULAA was completed without trocars in 91.2 % of patients. The surgical outcomes of SAG were significantly worse than those of MAG (p < 0.001). The surgical cost of gasless-TULAA was significantly lower than that of CMLA (p < 0.001).

Conclusion

Gasless-TULAA is a cost-effective, safe, and readily available surgical technique for mild appendicitis, which can obviate the need for specialized equipment.

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Conflict of interest

Koji Munakata, Junzo Shimizu, Mamoru Uemura, Masakazu Miyake, Taishi Hata, Kimimasa Ikeda, Keizo Dono, Masashi Kitada, Yuichiro Doki, and Masaki Mori have no conflicts of interest or financial ties to disclose.

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    Authors and Affiliations

    1. Department of Surgery, Toyonaka Municipal Hospital, 4-13-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan

      Koji Munakata, Junzo Shimizu, Masakazu Miyake, Taishi Hata, Kimimasa Ikeda, Keizo Dono & Masashi Kitada

    2. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan

      Koji Munakata, Mamoru Uemura, Taishi Hata, Yuichiro Doki & Masaki Mori

    3. Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, Sakai City, Osaka, 591-8025, Japan

      Junzo Shimizu

    4. Department of Surgery, Minoh City Hospital, 5-7-1 Kayano, Minoh City, Osaka, 562-0014, Japan

      Kimimasa Ikeda

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    1. Koji Munakata
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    Correspondence to Mamoru Uemura or Junzo Shimizu.

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    Mamoru Uemura and Junzo Shimizu have contributed equally to this work.

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    Munakata, K., Uemura, M., Shimizu, J. et al. Gasless transumbilical laparoscopic-assisted appendectomy as a safe and cost-effective alternative surgical procedure for mild acute appendicitis. Surg Today 46, 319–325 (2016). https://doi.org/10.1007/s00595-015-1177-4

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    • DOI: https://doi.org/10.1007/s00595-015-1177-4

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