Pediatric Surgery, Woman and Child Health Department, Hospital of Padua, Padua, Italy.
Pediatric Surgery, Santa Chiara Hospital, Trento, Italy.
Pediatr Surg Int. 2024 Feb 3;40(1):50. doi: 10.1007/s00383-023-05624-6.
Transumbilical laparoscopic-assisted surgery (TULS) mixed benefits of laparoscopic and open surgeries. Transumbilical laparoscopic-assisted appendectomy (TULAA) is a well-known procedure, accepted and currently used by pediatric surgeons for treatment of uncomplicated appendicitis (UA). There is no current agreement in its use for the complicated appendiceal infections (CA). We reported our results using TULAA for both UA and CA.
We retrospectively collected TULAA performed between April 2017 and April 2022. Appendicitis were classified in UA and CA. We analyzed conversion rate, operative time, length of stay, surgical site infections (SSIs) rate, postoperative intra-abdominal abscess and costs.
Over 5 years, 316 children underwent TULAA. Conversion rate was 3%. Mean age at surgery was 9.36 years (IQR 2-16). Forty-nine appendicitis were CA. Operative time and hospital stay was higher in CA than in UA group (38.33 vs. 60.73 min, p < 0.00001; 4 vs. 7 days, p < 0.00001). SSIs rate showed no statistically significant difference between two groups. Incidence of postoperative intra-abdominal collections was 11% in CA and 1% in UA. TULAA's cost was 192.07 €.
In our series, TULAA seems to be safe, feasible and cost-effective for both uncomplicated and complicated appendicitis, with no disadvantage in terms of outcomes compared to what is reported in literature for CLS.
经脐腹腔镜辅助手术（TULS）结合了腹腔镜和开放手术的优点。经脐腹腔镜辅助阑尾切除术（TULAA）是一种众所周知的手术，已被儿科外科医生接受并广泛应用于治疗单纯性阑尾炎（UA）。对于复杂的阑尾感染（CA），目前尚无共识。我们报告了使用 TULAA 治疗 UA 和 CA 的结果。
我们回顾性收集了 2017 年 4 月至 2022 年 4 月期间进行的 TULAA 手术。将阑尾炎分为 UA 和 CA。我们分析了转化率、手术时间、住院时间、手术部位感染（SSI）率、术后腹腔脓肿和费用。
5 年来，316 名儿童接受了 TULAA 手术。转化率为 3%。手术时的平均年龄为 9.36 岁（IQR 2-16）。49 例阑尾炎为 CA。CA 组的手术时间和住院时间均长于 UA 组（38.33 分钟 vs. 60.73 分钟，p<0.00001；4 天 vs. 7 天，p<0.00001）。两组 SSI 发生率无统计学差异。CA 组术后腹腔脓肿发生率为 11%，UA 组为 1%。TULAA 的费用为 192.07 欧元。
在我们的系列研究中，TULAA 似乎对单纯性和复杂性阑尾炎都是安全、可行和具有成本效益的，与文献报道的 CLS 相比，在结局方面没有劣势。
