Update on Transumbilical Single-Incision Laparoscopic Assisted Appendectomy (TULAA) – Which Children Benefit and What are the Complications?

Abstract

Background Transumbilical laparoscopic-assisted appendectomy (TULAA) is fast and cost-effective since no endoloops, staplers or wound protection devices are used. We analyzed the effects of TULAA as first approach for perforated (PA) and non-perforated (NPA) appendicitis in children.

Patients We performed a retrospective analysis of 181 children for whom TULAA was the first approach for appendicitis between October 2010 and March 2016.

Methods Morbidity, additional laparoscopic instrument insertion (AI), conversions to open extraumbilical appendectomy (OC), and complications were evaluated.

Results TULAA was initiated in 181 (87.4%) children (113 boys: 68 girls). Median age was 10.3 years (3.3–13.9 years) and BMI 16.8 kg/m2 (12.4–30.8). Appendicitis was non-perforated in 157 (86.7%) and perforated in 24 (13.3%) patients. TULAA was finalized in 142 (78.5%) patients, AI were inserted in 20 (11%) and OC were performed in 19 (10.5%) patients. Duration of surgery did not exceed 20 min for 12.8%, and 30 min for 43.6% of patients with TULAA and NPA. The rate of wound infections did not differ between procedures (TULAA 3/142 (2.1%), AI 0 (0%), OC 1/19 (5.3%), P=1.000). Further postoperative course was uneventful in 179 (98.9%) patients.

Conclusion TULAA can be used as first approach for appendicitis in all children with a low rate of complications. Extracorporeal appendix stump closure can be safely achieved in the majority of children without using laparoscopic disposable devices.

Zusammenfassung

Hintergrund Die transumbilikale laparoskopisch assistierte Appendektomie (TULAA) ist aufgrund des Verzichts auf endoskopisches Einweg-Material schnell und kostengünstig. Wir untersuchten die Auswirkungen von TULAA als primäres Verfahren bei perforierter (PA) und nicht perforierter (NPA) Appendizitis im Kindesalter.

Patienten Wir führten eine retrospektive Analyse bei 181 Kindern durch, bei denen zwischen Oktober 2000 und März 2016 TULAA als primäres Verfahren zur Behandlung der Appendizitis eingesetzt wurde.

Methoden Erfasst wurden Morbidität, die Insertion zusätzlicher laparoskopischer Instrumente (AI), Konversionen zur offenen extraumbilikalen Appendektomie (OC) und Komplikationen.

Ergebnisse TULAA wurde bei 181 Kindern begonnen (87,4%) (113 Jungen: 68 Mädchen). Das mediane Alter betrug 10,3 Jahre (3,3 – 13,9) und der BMI 16.8 kg/m2 (12,4–30,8). NPA lag in 157 (86,7%) und PA in 24 (13.3%) Patienten vor. TULAA wurde in 142 (78,5%) durchgeführt, AI erfolgte in 20 (11%) und OC in 19 (10,5%) Patienten. Die OP-Dauer überschritt nicht 20 Min bei 12,8%, und nicht 30 Min bei 43,6% der Patienten mit TULAA und NPA. Die Rate von Wundheilungsstörungen unterschied sich nicht zwischen den OP-Verfahren (TULAA 3/142 (2,1%), AI 0 (0%), OC 1/19 (5,3%), P=1,000). Der postoperative Verlauf gestaltete sich komplikationslos in 179 (98,9%) Patienten.

Zusammenfassung TULAA kann als primäres Appendektomie-Verfahren mit einer niedrigen Komplikationsrate bei allen Kindern verwendet werden. Der extrakorporale Appendixstumpfverschluß kann bei den meisten Kindern ohne Einsatz von endoskopischem Einweg-Material durchgeführt werden.

Key words

appendicitis - children - single incision - TULAA

Schlüsselwörter

Appendizitis - Kinder - single incision - TULAA

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