Abdullah Mohamad, Al-Taher Raed, Abdin Basil, Abbad Mutaz, Khris Ibraheem, Atieh Duha, Matar Sajeda Ghassan, Nawaiseh Mohammed Bassam
Department of Paediatric Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
Department of General Surgery, Division of Pediatric Surgery, School of Medicine, University of Jordan, Amman, Jordan.
J Indian Assoc Pediatr Surg. 2025 May-Jun;30(3):369-376. doi: 10.4103/jiaps.jiaps_264_24. Epub 2025 Apr 14.
To compare the gold standard method of managing acute appendicitis; laparoscopic appendectomy (LA) to transumbilical laparoscopic-assisted appendectomy (TULAA).
A randomized clinical study of consecutive pediatric patients (age under 13 years) undergoing appendectomy for noncomplicated acute appendicitis was conducted at a tertiary center in Jordan. Data collected included; perioperative parameters, operative time, gas time, postoperative hospital stay, pathology, complications, pain, and cost.
Out of the 50 initially enrolled patients, 47 were included in the analysis (25 in TULAA group [53.2%], 22 in LA group [46.8%]), of which only 12% and 31% of patients had perforated appendicitis, in the TULAA group and LA group consecutively. No early intraoperative complications were observed. Postoperative complications were seen in 4.8% of the LA group and 4% in the TULAA group. TULAA had significantly shorter operative time, lower gas flow, gas time, gas pressure levels, and more cases (68%) were operated without gas use compared to LA. Pain relief, diet resumption, cosmetic, and hospital stay did not significantly differ between the groups. The cosmetic outcome was slightly better in the TULAA group but not statistically significant.
TULLA offers an alternative approach to LA for acute appendicitis and may be of benefit in resource-poor institutions whilst maintaining the benefits of the minimally invasive approach. This study has demonstrated a significantly reduced wound infection, operative time, and gaseous insufflation for TULLA compared to LA. Further studies to demonstrate its feasibility in complicated appendicitis may be warranted.
比较急性阑尾炎的金标准治疗方法——腹腔镜阑尾切除术（LA）与经脐腹腔镜辅助阑尾切除术（TULAA）。
在约旦的一家三级中心，对连续接受非复杂性急性阑尾炎阑尾切除术的儿科患者（年龄在13岁以下）进行了一项随机临床研究。收集的数据包括围手术期参数、手术时间、气腹时间、术后住院时间、病理、并发症、疼痛和费用。
在最初纳入的50例患者中，47例纳入分析（TULAA组25例[53.2%]，LA组22例[46.8%]），其中TULAA组和LA组分别仅有12%和31%的患者患有穿孔性阑尾炎。未观察到早期术中并发症。LA组术后并发症发生率为4.8%，TULAA组为4%。与LA相比，TULAA的手术时间明显更短，气体流量、气腹时间、气压水平更低，且更多病例（68%）在无气腹情况下进行手术。两组之间在疼痛缓解、饮食恢复、美观效果和住院时间方面无显著差异。TULAA组的美观效果略好，但无统计学意义。
TULLA为急性阑尾炎提供了一种替代LA的方法，在资源匮乏的机构中可能有益，同时保持了微创方法的优势。本研究表明，与LA相比，TULLA的伤口感染、手术时间和气腹明显减少。可能需要进一步研究以证明其在复杂性阑尾炎中的可行性。
