Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan.
J Laparoendosc Adv Surg Tech A. 2024 Apr;34(4):380-385. doi: 10.1089/lap.2023.0275.
Transumbilical laparoscopy-assisted appendectomy (TULAA) is the technique of choice for all types of appendicitis. However, the technique is challenging for trainees to learn in comparison with performing conventional three-port laparoscopic appendectomy (CTPLA) in children. We aimed to compare the surgical outcomes of children with appendicitis treated by TULAA versus CTPLA performed by pediatric surgeons in training (PSITs). This retrospective study analyzed pediatric patients with acute appendicitis treated with CTPLA or TULAA between April 2016 and December 2022. Operative time (OT: minutes), pneumoperitoneum time (PT: minutes), blood loss (milliliter), length of hospital stay (days), and surgical site infection rate were compared between the two groups. Operative outcomes were also analyzed according to type of appendicitis such as uncomplicated and complicated cases. Two hundred twenty-five laparoscopic appendectomies were performed by CTPLA ( = 94) or TULAA ( = 131). All cases were performed by PSITs and there was no open conversion cases. TULAA had a shorter OT (67.0 ± 28.4 versus 78.3 ± 21.7; < .01) and PT (26.1 ± 17.4 versus 52.5 ± 22.1 min; < .01). The surgical site infection rate was slightly higher in the TULAA group, but the difference was not statistically significant. In uncomplicated appendicitis ( = 164), significant differences between the CTPLA and TULAA groups were observed in OT (CTPLA versus TULAA: 70.7 ± 14.9 versus 59.1 ± 21.6, < .01) and PT (CTPLA versus TULAA: 43.6 ± 13.1 versus 20.4 ± 13.6, < .01). With regard to postoperative complications, only surgical site infection was significantly different between the CTPLA and TULAA groups (CTPLA: 0.0% versus TULAA: 8.2%, < .05). In complicated cases ( = 61), there were significant differences between the groups in PT (CTPLA versus TULAA: 73.4 ± 24.9 versus 42.3 ± 17.2, < .01) and length of hospital stay (CTPLA versus TULAA: 7.0 ± 1.3 versus 8.9 ± 4.7, < .05). TULAA had a shorter OT and PT than CTPLA. TULAA for PSITs shows similar safety and feasibility to CTPLA for not only uncomplicated cases but also complicated cases.
经脐腹腔镜辅助阑尾切除术（TULAA）是治疗各种类型阑尾炎的首选技术。然而，与儿童传统三孔腹腔镜阑尾切除术（CTPLA）相比，该技术对受训者来说更具挑战性。我们旨在比较由儿科外科住院医师（PSITs）进行的 TULAA 与 CTPLA 治疗阑尾炎患儿的手术结果。这项回顾性研究分析了 2016 年 4 月至 2022 年 12 月期间接受 CTPLA 或 TULAA 治疗的急性阑尾炎患儿。比较了两组的手术时间（OT：分钟）、气腹时间（PT：分钟）、失血量（毫升）、住院时间（天）和手术部位感染率。根据阑尾炎的类型，如单纯性和复杂性病例，还分析了手术结果。 225 例腹腔镜阑尾切除术采用 CTPLA（ = 94）或 TULAA（ = 131）。所有病例均由 PSITs 完成，无开放转换病例。TULAA 的 OT（67.0 ± 28.4 与 78.3 ± 21.7； < .01）和 PT（26.1 ± 17.4 与 52.5 ± 22.1； < .01）更短。TULAA 组的手术部位感染率略高，但差异无统计学意义。在单纯性阑尾炎（ = 164）中，CTPLA 组和 TULAA 组在 OT（CTPLA 与 TULAA：70.7 ± 14.9 与 59.1 ± 21.6； < .01）和 PT（CTPLA 与 TULAA：43.6 ± 13.1 与 20.4 ± 13.6； < .01）方面存在显著差异。关于术后并发症，只有 CTPLA 组和 TULAA 组的手术部位感染存在显著差异（CTPLA：0.0%与 TULAA：8.2%； < .05）。在复杂性病例（ = 61）中，两组在 PT（CTPLA 与 TULAA：73.4 ± 24.9 与 42.3 ± 17.2； < .01）和住院时间（CTPLA 与 TULAA：7.0 ± 1.3 与 8.9 ± 4.7； < .05）方面存在显著差异。 TULAA 的 OT 和 PT 均短于 CTPLA。TULAA 对 PSITs 来说，无论是在单纯性病例还是复杂性病例中，其安全性和可行性与 CTPLA 相似。
