Massachusetts Chapter of the American College of Surgeons

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The Transumbilical Laparoscopic-assisted Approach is Superior to the 3-trocar Standard Laparoscopic Approach for Interval Appendectomy in Children
Nikki M. Check, PA-C, Nicole Wynne, BS, David P. Mooney, MD, MPH
Boston Children's Hospital, Boston, MA

The transumbilical laparoscopic-assisted approach (TULAA) has been reported to be less expensive and cosmetically superior to the standard 3-trocar laparoscopic approach (SLA) for appendectomy in children.

Records of children who underwent interval appendectomy at a single institution from February, 2006 to August, 2018 were identified using a data warehouse text search tool. Data were extracted from the electronic medical record. Patients who underwent TULAA were matched 1:3 with those who underwent SLA for: age, time from initial presentation to interval appendectomy, drain placement and the presence of acute inflammation on pathology. Outcome data including length of interval appendectomy procedure, length of post-interval appendectomy hospital stay, cost of care, and complication rate were compared after matching.

41 patients underwent TULAA, all by a single surgeon and 444 children underwent SLA by one of 18 surgeons. After matching, operative time was significantly less for the 41 TULAA patients: 61 minutes (range 49 to 75) compared with 83 minutes (67 to 103) for the 123 SLA patients, p<.01. Length of stay was 1.1 days (1.0 to 1.2) versus 1.17 days (1.1 to 1.3), p= 0.035. Average cost of the procedure was $1,215 less for TULAA compared to SLA, with shortened operating room time and minimized equipment being the major contributors. The complication rate was 7.3% in TULAA versus 9.7% in SLA.

This report demonstrates that TULAA is valuable in children with the most difficult of appendectomies, an interval appendectomy.

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