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. 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.

journal_name

Klin Padiatr

journal_title

Klinische Padiatrie

authors

Dübbers M,Nikolaou E,Fuchs H,Fischer J,Alakus H,Leers J,Bruns C,Cernaianu G

doi

10.1055/s-0044-101622

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

194-199

issue

4

eissn

0300-8630

issn

1439-3824

journal_volume

230

pub_type

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