Skip to main content
SpringerLink
Log in

Transumbilical laparoscopic-assisted appendectomy in children: is it worth it?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Transumbilical laparoscopic-assisted appendectomy (TULAA) is the technique of choice for all types of appendicitis in our Department. It combines the advantages of laparoscopy (global vision and minimally invasion) and open surgery (lower cost). The objective was to assess the results of our TULAA series and compare them to the results of standard laparoscopic appendectomies (SLA) performed during the same period.

Methods

Retrospective review of total appendectomies performed since TULAA introduction (September 2003 to December 2015) with statistic analysis of the results.

Results

A total of 1309 patients underwent TULAA approach, but 126 (9.6%) needed reconversion to open appendectomy, 1 (0.08%) to SLA, and 9 (0.7%) introduction of a second port. Mean age and weight of patients was 121.5 ± 36 months and 37.6 ± 14 kg, respectively. Mean operative time was 40.9 ± 15.5 min, ranging from 11 to 110. All types of appendicitis were present, with 394 being complicated (29.9%). Postoperative complications were seen in 168 patients (14.3%), 37 being readmitted (3.2%), and only five needing reintervention (Two intestinal occlusions and three abscess debridement). When comparing TULAA and SLA, there were no significant differences in the length of hospitalization, time to tolerate soft diet, analgesic requirements, and complications depending on the type of appendicitis, but TULAA was significantly faster and cheaper (average 900€).

Conclusions

In our hands, TULAA has shown to be effective, easy to learn, and fast to perform. Low surgical cost is probably its principal advantage, which might be encouraging in times of crisis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64

    Article  CAS  PubMed  Google Scholar 

  2. Dingemann J, Ure BM (2013) Systematic review of level 1 evidence for laparoscopic pediatric surgery: do our procedures comply with the requirements of evidence-based medicine? Eur J Pediatr Surg 23:474–479

    Article  PubMed  Google Scholar 

  3. Li X, Zhang J, Sang L, Zhang W, Chu Z, Liu Y (2010) Laparoscopic versus conventional appendectomy–a meta-analysis of randomized controlled trials. BMC Gastroenterol 10:129

    Article  PubMed  PubMed Central  Google Scholar 

  4. Michailidou M, Goldstein SD, Sacco Casamassima MG, Salazar JH, Elliott R, Hundt J, Abdullah F (2015) Laparoscopic versus open appendectomy in children: the effect of surgical technique on healthcare costs. Am J Surg 210:270–275

    Article  PubMed  Google Scholar 

  5. Ukai T, Shikata S, Takeda H, Dawes L, Noguchi Y, Nakayama T, Takemura YC (2016) Evidence of surgical outcomes fluctuates over time: results from a cumulative meta-analysis of laparoscopic versus open appendectomy for acute appendicitis. BMC Gastroenterol 16:37

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hermans BP, Otte JB (1997) Laparoscopic appendicectomy: pros & cons–literature review of 4190 cases. Acta Chir Belg 97:110–117

    CAS  PubMed  Google Scholar 

  7. Pelosi MA, Pelosi MA 3rd (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594

    CAS  PubMed  Google Scholar 

  8. Esposito C (1998) One-trocar appendectomy in pediatric surgery. Surg Endosc 12:177–178

    Article  CAS  PubMed  Google Scholar 

  9. Boo YJ, Lee Y, Lee JS (2016) Comparison of transumbilical laparoscopic-assisted appendectomy versus single incision laparoscopic appendectomy in children: which is the better surgical option? J Pediatr Surg 51:1288–1291

    Article  PubMed  Google Scholar 

  10. Montalto AS, Impellizzeri P, Grasso M, Antonuccio P, Crisafi C, Scalfari G, Arena F, Salpietro C, Lima M, Romeo C (2014) Surgical stress after open and transumbilical laparoscopic-assisted appendectomy in children. Eur J Pediatr Surg 24:174–178

    PubMed  Google Scholar 

  11. Bergholz R, Klein I, Wenke K, Boettcher M, Reinshagen K, Krebs T (2015) Midterm outcome of transumbilically laparoscopic-assisted versus laparoscopic and open appendectomy in children–a matched prospective study. Eur J Pediatr Surg 25:216–219

    PubMed  Google Scholar 

  12. Sesia SB, Berger E, Holland-Cunz S, Mayr J, Hacker FM (2015) Laparoscopy-assisted single-port appendectomy in children: safe alternative also for perforated appendicitis? Medicine (Baltimore) 94:e2289

    Article  Google Scholar 

  13. Chandler NM, Ghazarian SR, King TM, Danielson PD (2014) Cosmetic outcomes following appendectomy in children: a comparison of surgical techniques. J Laparoendosc Adv Surg Tech A 24:584–588

    Article  PubMed  Google Scholar 

  14. Malik AM, Talpur AH, Laghari AA (2009) Video-assisted laparoscopic extracorporeal appendectomy versus open appendectomy. J Laparoendosc Adv Surg Tech A 19:355–359

    Article  PubMed  Google Scholar 

  15. Noviello C, Romano M, Martino A, Cobellis G (2015) Transumbilical laparoscopic-assisted appendectomy in the treatment of acute uncomplicated appendicitis in children. Gastroenterol Res Pract 2015:949162

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ohno Y, Morimura T, Hayashi S (2012) Transumbilical laparoscopically assisted appendectomy in children: the results of a single-port, single-channel procedure. Surg Endosc 26:523–527

    Article  PubMed  Google Scholar 

  17. Stylianos S, Nichols L, Ventura N, Malvezzi L, Knight C, Burnweit C (2011) The “all-in-one” appendectomy: quick, scarless, and less costly. J Pediatr Surg 46:2336–2341

    Article  PubMed  Google Scholar 

  18. Valla J, Ordorica-Flores RM, Steyaert H, Merrot T, Bartels A, Breaud J, Ginier C, Cheli M (1999) Umbilical one-puncture laparoscopic-assisted appendectomy in children. Surg Endosc 13:83–85

    Article  CAS  PubMed  Google Scholar 

  19. Deie K, Uchida H, Kawashima H, Tanaka Y, Masuko T, Takazawa S (2013) Single-incision laparoscopic-assisted appendectomy in children: exteriorization of the appendix is a key component of a simple and cost-effective surgical technique. Pediatr Surg Int 29:1187–1191

    Article  PubMed  Google Scholar 

  20. Karakus OZ, Ulusoy O, Ates O, Hakguder G, Olguner M, Akgur FM (2016) Conventional single-port laparoscopic appendectomy for complicated appendicitis in children: efficient and cost-effective. J Minim Access Surg 12:16–21

    Article  PubMed  PubMed Central  Google Scholar 

  21. St Peter SD, Adibe OO, Juang D, Sharp SW, Garey CL, Laituri CA, Murphy JP, Andrews WS, Sharp RJ, Snyder CL, Holcomb GW 3rd, Ostlie DJ (2011) Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg 254:586–590

    Article  PubMed  Google Scholar 

  22. Koontz CS, Smith LA, Burkholder HC, Higdon K, Aderhold R, Carr M (2006) Video-assisted transumbilical appendectomy in children. J Pediatr Surg 41:710–712

    Article  PubMed  Google Scholar 

  23. Codrich D, Scarpa MG, Lembo MA, Pederiva F, Olenik D, Gobbo F, Giannotta A, Cherti S, Schleef J (2013) Transumbilical laparo-assisted appendectomy: a safe operation for the whole spectrum of appendicitis in children-a single-centre experience. Minim Invasive Surg 2013:216416

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Kulaylat AN, Podany AB, Hollenbeak CS, Santos MC, Rocourt DV (2014) Transumbilical laparoscopic-assisted appendectomy is associated with lower costs compared to multiport laparoscopic appendectomy. J Pediatr Surg 49:1508–1512

    Article  PubMed  Google Scholar 

  25. Visnjic S (2008) Transumbilical laparoscopically assisted appendectomy in children: high-tech low-budget surgery. Surg Endosc 22:1667–1671

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Complejo Hospitalario de Navarra, Irunlarrea, 4, 31008, Pamplona, Spain

    Sara Hernandez-Martin, Lidia Ayuso, Ada Yessenia Molina, Javier Pison, Miguel Angel Martinez-Bermejo & Alberto Perez-Martinez

Authors
  1. Sara Hernandez-Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lidia Ayuso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ada Yessenia Molina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Javier Pison
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Miguel Angel Martinez-Bermejo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alberto Perez-Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara Hernandez-Martin.

Ethics declarations

Disclosures

Drs. Sara Hernandez-Martin, Lidia Ayuso, Ada Yessenia Molina, Javier Pison, Miguel Angel Martinez-Bermejo, and Alberto Perez-Martinez have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hernandez-Martin, S., Ayuso, L., Molina, A.Y. et al. Transumbilical laparoscopic-assisted appendectomy in children: is it worth it?. Surg Endosc 31, 5372–5380 (2017). https://doi.org/10.1007/s00464-017-5618-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5618-6

Keywords

Search

Navigation