Single-center comparison of outcomes between laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy

• Published in: Journal of pediatric surgery 2023-05, Vol.58 (5), p.838-843
• Main Authors: John, Rebecca, Yu, Peter T., Reyna, Troy, Guner, Yigit, Promprasert, Patcharada, Hill, Trevor, Sayrs, Lois, Stottlemyre, Rachael L., Morphew, Tricia, Awan, Saeed
• Format: Article
• Language: English
• Subjects: Appendectomy; Appendectomy - adverse effects; Appendectomy - methods; Appendicitis - surgery; Child; Female; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Length of Stay; Male; Pain; Pediatric; Retrospective Studies; Single incision appendectomy; Surgery; Treatment Outcome; Umbilicus - surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2023.01.033

Appendectomy is the most common pediatric emergency surgery performed to date. This study compared outcomes between laparoscopic appendectomy (LA) and transumbilical laparoscopic assisted appendectomy (TULAA) for 1154 uncomplicated patients across 5 years at a single institution. Primary outcomes include length of stay (LOS), post-operative complications, pain score, and operating room (OR) time. Demographic and clinical data was collected for 1154 eligible patients treated for uncomplicated appendicitis between August 2014–October 2019, with 830 patients in the LA group, and 324 in the TULAA group. Mixed effects modeling procedure using logistic and linear regression examined the effect of surgery type on the four primary outcomes after adjustment for potential clustering effect of surgeon and confounding factors. Of 1154 patients, 62.7% were male, and mean (SD) age was 10.9 (3.6) years. Median [IQR] LOS was 28.0 h [22.0, 36.0], mean (SD) OR time was 29.0 (10.0) minutes, and median [IQR] pain at maximum level was 5.5 (2.7). The complication rate overall was  0.05). OR time was reduced by an average of 5.2 min in the TULAA group (p  0.05), and patients were more likely to be discharged within 24 h in patients who underwent TULAA (OR = 5.3 [1.6, 17.4], p = 0.007). Retrospective analysis of 1154 pediatric appendectomies, found no difference in complications between single- and three-incision laparoscopic procedures (TULAA vs. LA). Findings suggest TULAA is a safe procedure for acute appendicitis in pediatrics. IV. •There are very few studies comparing LA to TULAA.•Current research has mixed results when comparing laparoscopic appendectomy to TULAA.•This study found no difference in complications between single- and three-incision laparoscopic procedures (TULAA vs. LA).•This is the largest known comparative study between LA and TULAA with data was collected for 1154 patients treated for uncomplicated appendicitis.