Is Transumbilical Laparoscopic-assisted Appendectomy Better than Laparoscopic Appendectomy in Children? A Randomized Controlled Study.

Aim: To compare the gold standard method of managing acute appendicitis; laparoscopic appendectomy (LA) to transumbilical laparoscopic-assisted appendectomy (TULAA).

Methods: 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.

Results: 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.

Conclusion: 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.