title: Transumbilical laparoscopically assisted appendectomy: an alternative minimally invasive technique in pediatric patients.
abstract: BACKGROUND
  Transumbilical laparoscopically assisted appendectomy (TULAA) has been reported in the literature as an alternative to traditional three-port laparoscopic appendectomy (LA). Our study compares outcomes between LA and the one-trocar transumbilical technique in a single institution over a concurrent time frame for all cases of pediatric appendicitis.
  
  
  METHODS
  An Institutional Review Board-approved retrospective chart review of all appendectomies from July 2007 through June 2009 was performed. All appendectomies were performed either laparoscopically or transumbilically. One surgeon predominantly used the TULAA method, whereas the other 2 surgeons used strictly the LA method. No cases were converted to open. Categorization of specimens as normal, acute, or ruptured was based on pathology reports. Outcomes analyzed for each group included surgical duration, cost, length of stay, fever (>101.5F), wound infection, ileus, and postoperative abdominal-pelvic abscess.
  
  
  RESULTS
  A total of 131 appendectomies were performed by 3 surgeons, 83 were LA and 48 were TULAA. For all stages of appendicitis, outcomes differed significantly only for operating room cost, with the TULAA being significantly less expensive. All other outcomes were similar between the two techniques.
  
  
  CONCLUSIONS
  Our study suggests that TULAA is a reasonable alternative to the standard minimally invasive technique for appendicitis in both acute and ruptured situations. All analyzed complications were similar between the groups, suggesting that TULAA is an acceptable surgical method in pediatric patients for all stages of appendicitis.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA. amy.b.stanfill@osfhealthcare.org
authors.forename: Amy B
authors.initials: AB
authors.lastname: Stanfill
authors.forename: Danielle K
authors.initials: DK
authors.lastname: Matilsky
authors.forename: Kavitha
authors.initials: K
authors.lastname: Kalvakuri
authors.forename: Richard H
authors.initials: RH
authors.lastname: Pearl
authors.forename: Lizabeth J
authors.initials: LJ
authors.lastname: Wallace
authors.forename: Ravindra K
authors.initials: RK
authors.lastname: Vegunta
mesh_terms: D000367:Age Factors; D001062:Appendectomy / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008297:Male; D057605:Natural Orifice Endoscopic Surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus