期刊名称：Journal of Minimally Invasive Surgical Sciences
印刷版ISSN：2251-7022
电子版ISSN：2251-7030
出版年度：2014
卷号：3
期号：3
出版社：Kowsar
摘要：Background: The use of laparoscopic appendectomy for pediatric patients has been widely accepted and three trocars are usually necessary to perform a conventional laparoscopic appendectomy. However, single-port appendectomy represents an attractive alternative for children. Recently the use of a single umbilical incision to perform an appendectomy has been described. Objectives: The purpose of this study was to review our initial experience with transumbilical laparoscopic-assisted appendectomy (TULAA) in the pediatric population. Patients and Methods: A retrospective review of all pediatric patients aged 3-16 (median: 10.2 years) treated for appendicitis was performed from Jan 2010 to July 2013. Five mm infraumbilical port was used as camera port at 6 O’ clock position. The incision was extended along the border of umbilicus to 9 O’ clock position and another 5 mm working instrument was passed through different subfascial opening in the same incision. Patients variables (age and sex), intra-operative findings, duration of surgery, duration of stay, time of discharge, course in the ward, postoperative events like pain, nausea, vomiting and wound status were assessed. Postoperatively patients were followed up after 10 days, 3 months and 6 months. Cosmetic evaluation was done at 3rd and 6th months. Results: Of 58 patients undergoing TULLA, 55 patients underwent TULAA successfully. The mean operative time was 52 minutes. Overall, the average length of stay was 1.2 ± 0.8 days. Postoperative course was uneventful in all the patients. There were no significant episodes of nausea, vomiting and pain. Postoperatively at 3rd and 6th months of follow-up the appearance of scar was cosmetically acceptable to every patient as well as their parents. It is much cheaper because the procedure can be performed using only one camera port and another 5 mm instrument without the need of additional port. There is no need to use endoloops, staplers or electrocautery devices. None of our patients had any late post-operative complications (adhesive obstructions or port site herniation). Cases of advanced appendicitis may require additional trocars or "conversion" to conventional laparoscopic techniques. Conclusions: The TULAA procedure is a preferable operation for interval appendectomy in children because it is simple and provides good cosmetic results.
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