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Background: Since conventional laparoscopic appendectomy (LA) has become routine, several modifications exist that promote cosmesis and efficiency. Single incision appendectomy has improved cosmetic results, but requires expensive equipment and specialized training. The Trans-Umbilical Laparoscopic Assisted Appendectomy (TULAA) offers a similar cosmetic result as a single incision appendectomy, but utilizes standard laparoscopic equipment. We hypothesized our TULAA experience would show quicker operative times, less expensive disposable equipment, and equivalent morbidity to a contemporaneous group of LA patients.
Methods: Records of consecutive children who underwent a TULAA for acute appendicitis were compared to LA patients of similar age and gender. Data analyzed included gender, age in years, length of operation, length of time in the operating room, length of hospital stay, and postoperative complications. A Student's two sided t test was used for comparison of means, and a p-value of <.05 was considered statistically significant.
Results: 71 patients who underwent TULAA were compared to a group of 71 LA patients of the same age and gender. Mean operating time in the TULAA group was 42.1 ± 10.6 vs. 62.5 ± 13.8 minutes in the LA group (p <.05) and respective time in the OR was 79.8 ± 14.0 vs 106.1 ± 15.6 (p <.05). Average OR disposable equipment cost was also significantly less in the TULAA group (\.50 vs \.90, p < .05). No cases in either group were converted to open procedures. There was no significant difference between TULAA and LA groups in terms of morbidity.
Conclusion: The TULAA is an efficient, feasible modification of conventional laparoscopic appendectomy that is cosmetically superior while quicker, less expensive and associated with no difference in morbidity.