Transumbilical laparoscopic-assisted appendectomy in children: Clinical and surgical outcomes

Abstract

The aim of this paper is to present and describe transumbilical laparoscopic-assisted appendectomy in children, focusing on its technical aspects and clinical and surgical outcomes. The surgical charts of all patients aged between 0 and 14 years treated with transumbilical laparoscopic-assisted appendectomy admitted to the authors' institution from January 2009 to September 2013 with a diagnosis of suspected appendicitis following clinical, laboratory and ultrasound findings were reviewed. Operating time, intraoperative findings, need for conversion or for additional trocars, and surgical complications were reported. During the study period, 120 patients aged between 6 and 14 years (mean age: 9.9 years), 73 females (61%) and 47 males (39%), were treated with transumbilical laparoscopic-assisted appendectomy. There were 37 cases of hyperemic appendicitis (subserosal and retrocecal), 74 cases of phlegmonous appendicitis and 9 cases of perforated gangrenous appendicitis. It was not possible to establish a correlation between grade of appendicitis and mean operating time (P > 0.05). Eleven cases (9%) needed the use of one additional trocar, while 8 patients (6%) required conversion to the standard laparoscopic technique with the use of two additional trocars. No patient was converted to the open technique. Transumbilical laparoscopic-assisted appendectomy is a safe technique in children and it could be used by surgeons who want to approach other minimally invasive techniques.

Keywords: Appendectomy; Children; Minimally invasive surgery; Procedure; Transumbilical.

Figure 1

Surgical steps for video-assisted transumbilical appendectomy. A: Umbilical access for 10 mm port and operative camera; B: The appendix (phlegmonous) is externalized through the umbilicus; C: Open “classic” appendectomy; D: Skin closure: the umbilicus is closed with rapid 4/0 absorbable stitches.