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Evaluation of the single port trans-umbilical laparoscopic assisted appendectomy for non-complicated and perforated appendicitis in children

Alexis P Arnaud, Juliette Hascoet, Audrey Guinot, Edouard Habonimana, Olivier Azzis, Benjamin Fremond

Department of General Paediatric Surgery, University Hospital, Rennes, France



Aim: Evaluation of the single port trans-umbilical laparoscopic assisted appendectomy (TULAA) performed in children for non-complicated appendicitis and appendicular peritonitis.
Method: A retrospective cohort study of children operated on using the TULAA technique between 1 January 2008 and 1 January 2013 was performed. TULAA is a minimally invasive surgery using a 10mm single port and a 5mm laparoscopic grasper through a 10mm sidearm viewing telescope. The appendix is exteriorized through the umbilical incision, a conventional appendectomy is then performed extra corporeally. Data collected were: demographics, type of appendicitis, need to convert, operative time, per and postoperative complications. Data are given in median (range).
Results: TULAA was performed in 282 children. Patients were 10,3 years old (1.6; 17.8). There were 233 non-perforated appendicitis (83%) and 49 peritonitis (17%). TULAA completed the procedure in 255 cases (90.5%). Conversion to multiport surgery was required in 26 cases (9%): 14 appendicitis (6%) and 12 peritonitis (24%). Number of added port was: 1 in 15 cases (9 appendicitis and 6 peritonitis) and 2 in 11 cases (5 appendicitis and 6 peritonitis). One conversion to open surgery was needed for peritonitis. Peroperative rupture happened in 8 cases during exteriorization of the appendix. Operative time was 60 minutes (21; 205). Postoperative complications included 1 umbilical wound infection that required debridement under general anaesthesia and 7 intra-abdominal abscesses. The latter complication was treated conservatively in 5 cases, but 2 needed general anaesthesia: 1 for radiological drainage and 1 for a rectotomy. Hospital stay was 2 days
(0; 14) in non complicated appendicitis and 5 days (2; 14) in peritonitis.
Conclusion: TULAA is a feasible technique that can be used safely regardless of the perforation status with a high success rate and an excellent cosmetic result. This procedure should be recommended as a first approach in paediatric population.