Abstract
Background: The aim of this study is to determine the feasibility and safety of the single-port gasless trans-umbilical laparoscopically-assisted appendectomy in the pediatric age group at a single center in a tertiary university hospital in Jordan. Methods: Between April 2018 and July 2019, the surgical records of all patients aged between 0 and 13 years treated with trans-umbilical laparoscopic-assisted appendectomy TULAA for a suspected appendicitis following a clinical, laboratory and ultrasound findings were reviewed retrospectively. Baseline characteristics, white blood cell count, operative time, intraoperative findings, need for additional trocars or for conversion, length of hospital stay and surgical complications were reported.Results: 36 cases were included in the study, 23 (64%) were completed successfully using the gasless TULAA technique. Gas insufflation was needed in 10 (28%) cases and only 3 (8%) had to be converted to the three-port laparoscopic appendectomy technique. There was no significant difference between the gaseous and gasless groups in terms of baseline characteristics, BMI, surgery duration, postoperative recovery period or length of stay. However, the group of patients who needed gas insufflation to complete the procedure had a higher white blood cell count compared to the gasless group. The surgery was completed successfully by senior general surgery residents in 27 (75%) cases while the consultant’s intervention was needed in the remaining cases. The gasless TULAA group were less likely to require complex analgesia (i.e., IV analgesia) compared to the gasless group (OR=0.683).Conclusions: Gasless TULAA is a feasible procedure that can be performed safely by surgical residents as an initial approach for all grades of acute appendicitis in the pediatric age group.
Highlights
Acute appendicitis is the most common cause of acute abdomen in the pediatric age group with more than 78,000 cases reported in the United States yearly (Kozak, DeFrances, & Hall, 2006)
This technique requires the use a laparoscopic lens with pneumoperitoneum to exteriorize the inflamed appendix and perform a standard extracorporeal appendicectomy. It profited from new advancement in the field of laparoscopy to implement a new minimally invasive approach that combines the good visualization of laparoscopy and the ability to perform a safe traditional open appendectomy from a single small umbilical incision
To minimize the postoperative pain that might be caused by abdominal wall tension during pneumoperitoneum, gasless TULAA has been proposed as an innovative modification to the approach originally described by Pelosi and Pelosi
Summary
Acute appendicitis is the most common cause of acute abdomen in the pediatric age group with more than 78,000 cases reported in the United States yearly (Kozak, DeFrances, & Hall, 2006). The one-trocar appendectomy was first proposed by Pelosi and Pelosi (1992) This technique requires the use a laparoscopic lens with pneumoperitoneum to exteriorize the inflamed appendix and perform a standard extracorporeal appendicectomy. Valla et al (1999) was the first to present a large case series of pediatric patient treated using the Trans Umbilical Laparoscopically Assisted Appendectomy TULAA technique. The aim of this study is to determine the feasibility and safety of the single-port gasless trans-umbilical laparoscopically-assisted appendectomy in the pediatric age group at a single center in a tertiary university hospital in Jordan. Conclusions: Gasless TULAA is a feasible procedure that can be performed safely by surgical residents as an initial approach for all grades of acute appendicitis in the pediatric age group
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