Transumbilical Laparoscopic-Assisted Appendectomy (TULAA): A Fast, Safe, and Scarless Alternative to Conventional Three-Port Laparoscopic Appendectomy in Pediatric Patients

TL;DR

A new single-incision surgery for appendicitis in children is faster, less painful, and leaves no visible scar compared to traditional methods.

Contribution

The study introduces and validates TULAA as a scarless, efficient alternative to conventional laparoscopic appendectomy in pediatric patients.

Findings

TULAA had significantly shorter operative time and lower postoperative pain compared to CLA.

Hospital stay was shorter for patients undergoing TULAA.

Cosmetic outcomes were significantly better with TULAA.

Abstract

Introduction: Acute appendicitis is a common pediatric surgical emergency requiring timely intervention. Conventional three-port laparoscopic appendectomy (CLA) is widely used, offering reduced postoperative pain, faster recovery, and lower wound infection rates. The transumbilical laparoscopic-assisted appendectomy (TULAA) technique, a single-incision approach, promises improved cosmetic outcomes, shorter operative time, and reduced morbidity. This study aims to compare TULAA and CLA in terms of surgical efficiency, postoperative pain, complications, hospital stay, conversion rate, and cosmetic acceptance.

Materials and methods: This comparative study was conducted at Shri B.M. Patil Medical College, Vijayapura, India, from September 2023 to September 2024. A total of 36 patients under 18 years with appendicitis were enrolled (18 in the TULAA group and 18 in the CLA group). Primary outcomes assessed included operative time, pain (using visual analogue scale, or VAS), complications, wound issues, hospital stay, conversion rate, and cosmetic acceptance.

Results: TULAA demonstrated a significantly shorter operative time (p<0.001) and lower postoperative pain (p=0.0009) compared to CLA. Hospital stay was shorter in the TULAA group (p=0.0008). While no significant difference in postoperative complications (p=0.1456) was observed, cosmetic acceptance was notably better in TULAA (p<0.001).

Conclusion: TULAA is a quick, safe, and cosmetically superior alternative to CLA in pediatric appendicitis, offering shorter operative time, reduced pain, and enhanced recovery.

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