Transumbilical laparoscopic-assisted appendectomy (TULAA): a safe and useful alternative for uncomplicated appendicitis

Abstract

The aim of this study was a comparison of transumbilical laparoscopic-assisted appendectomy (TULAA) and open appendectomy (OA) in cases of acute uncomplicated appendicitis. Fifty-eight TULAA and 65 OA patients with a preoperative diagnosis of uncomplicated appendicitis were studied. Pneumoperitoneum was obtained with a transumbilical 10-mm trocar (telescope access) and 5-mm operative channel introduced in the left iliac fossa. Appendectomy was performed outside the abdomen, after exteriorization of the appendix through the transumbilical incision. In the TULAA group, operating time and hospital stay were reduced. Conversion was necessary in one case (1.7%), and in another case (1.7%) an additional 5-mm operative channel was introduced. Neither intra- nor postoperative complications were encountered in the TULAA group with excellent cosmetic results. There was one wound infection in the OA group (1.5%), and an enlargement of the incision became necessary in 8 cases (12.3%). It is concluded that TULAA is the best approach in uncomplicated appendicitis. It is less invasive and traumatic and permits a complete evaluation of the peritoneal cavity with superior cosmetic results, especially in obese patients and in cases of ectopic appendix.—Thomas A. Angerpointner The aim of this study was a comparison of transumbilical laparoscopic-assisted appendectomy (TULAA) and open appendectomy (OA) in cases of acute uncomplicated appendicitis. Fifty-eight TULAA and 65 OA patients with a preoperative diagnosis of uncomplicated appendicitis were studied. Pneumoperitoneum was obtained with a transumbilical 10-mm trocar (telescope access) and 5-mm operative channel introduced in the left iliac fossa. Appendectomy was performed outside the abdomen, after exteriorization of the appendix through the transumbilical incision. In the TULAA group, operating time and hospital stay were reduced. Conversion was necessary in one case (1.7%), and in another case (1.7%) an additional 5-mm operative channel was introduced. Neither intra- nor postoperative complications were encountered in the TULAA group with excellent cosmetic results. There was one wound infection in the OA group (1.5%), and an enlargement of the incision became necessary in 8 cases (12.3%). It is concluded that TULAA is the best approach in uncomplicated appendicitis. It is less invasive and traumatic and permits a complete evaluation of the peritoneal cavity with superior cosmetic results, especially in obese patients and in cases of ectopic appendix.—Thomas A. Angerpointner