title: Transumbilical laparoscopic assisted appendectomy compared with laparoscopic and laparotomic approaches in acute appendicitis.
abstract: BACKGROUND
  Acute appendicitis is the most common cause of acute abdominal surgery. Despite nearly three decades comparing laparoscopic with laparotomic appendectomy, the available scientific evidence does not show consensus of opinion about the best access for the treatment of acute appendicitis. The transumbilical laparoscopic assisted appendectomy combines the advantages of laparoscopic access to the simplicity of the laparotomic technique.
  
  
  OBJECTIVE
  To compare the three technical advantages showing possible tendency to transumbilical laparoscopic assisted appendectomy.
  
  
  METHODS
  This is a retrospective study comparing three series with 1232 patients. Variables were: operative time, hospital stay, early and late postoperative complications, postoperative pain and earlier return to daily activities.
  
  
  RESULTS
  The averaged surgical time was 59.8 min in laparotomic appendectomy, 75.5 min in laparoscopic appendectomy and 51,7 min in transumbilical laparoscopic assisted appendectomy with significant difference. The incidence of postoperative pain, general complications and wound infection were greater in the group submitted to laparotomic appendectomy. The earlier return to daily activities and short hospital stay were observed in groups laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy.
  
  
  CONCLUSIONS
  The effectiveness and safety of transumbilical laparoscopic assisted appendectomy can make this technique the preferred choice in the initial management of patients with acute appendicitis.
authors.affiliation: Serviço de Cirurgia Geral e Laparoscópica, Hospital Madre Teresa, Belo Horizonte, MG, Brazil. geraldos.lima@terra.com.br
authors.forename: Geraldo José de Souza
authors.initials: GJ
authors.lastname: Lima
authors.forename: Alcino Lázaro da
authors.initials: AL
authors.lastname: Silva
authors.forename: Rodrigo Fabiano Guedes
authors.initials: RF
authors.lastname: Leite
authors.forename: Gustavo Munayer
authors.initials: GM
authors.lastname: Abras
authors.forename: Eduardo Godoy
authors.initials: EG
authors.lastname: Castro
authors.forename: Livio José Suretti
authors.initials: LJ
authors.lastname: Pires
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008297:Male; D012189:Retrospective Studies; D014472:Umbilicus