title: Efficacy of transumbilical laparoscopic-assisted appendectomy for appendicitis: a four-year experience at a single center.
abstract: OBJECTIVE
  To compare the surgical outcomes after transumbilical laparoscopic-assisted appendectomy (TULAA) and open appendectomy (OA) at a single institution.
  
  
  METHODS
  We compared the surgical outcomes for 94 consecutive patients who underwent TULAA between April 2010 and March 2014 to those for 91 consecutive patients who underwent OA between April 2006 and March 2010.
  
  
  RESULTS
  There were no significant differences in the clinicopathological backgrounds between the two groups. Although the lengths of the operations were similar in both groups, the postoperative hospital stay was significantly shorter in the TULAA group (4.7 days vs. 5.4 days, P = 0.02). The need for abdominal drain insertion was significantly reduced in the TULAA group owing to sufficient intraperitoneal exploration (P = 0.03). The incidence of postoperative complications was also lower in the TULAA group, but the difference was not significant (8.6 % vs. 12.1 %, P = 0.31). In complicated cases, a lower incidence of surgical site infection was confirmed in the TULAA group (6.7 % vs. 20.7 %, P = 0.12).
  
  
  CONCLUSIONS
  Our results demonstrated that TULAA provided better surgical outcomes, especially a faster recovery. TULAA could be an effective procedure incorporating both open and laparoscopic techniques, and can be implemented as a standard procedure for the treatment of appendicitis, regardless of disease severity.
authors.affiliation: Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-Ku, Kyoto, 602-8319, Japan. nkoizumi@koto.kpu-m.ac.jp.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Koizumi
authors.affiliation: Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-Ku, Kyoto, 602-8319, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-Ku, Kyoto, 602-8319, Japan.
authors.forename: Yuen
authors.initials: Y
authors.lastname: Nakase
authors.affiliation: Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-Ku, Kyoto, 602-8319, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-Ku, Kyoto, 602-8319, Japan.
authors.forename: Kanehisa
authors.initials: K
authors.lastname: Fukumoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*; D055815:Young Adult
keywords: Complicated appendicitis; Open appendectomy; Single-incision laparoscopic surgery; Transumbilical laparoscopic-assisted appendectomy (TULAA)