title: Comparison of transumbilical laparoscopic-assisted appendectomy versus single incision laparoscopic appendectomy in children: which is the better surgical option?
abstract: BACKGROUND
  Transumbilical laparoscopic-assisted appendectomy (TULA) is a single incision technique that exteriorizes the appendix through the umbilicus. The aim of this study was to compare the surgical outcomes of TULA with SILA in pediatric appendicitis.
  
  
  METHODS
  A retrospective review of medical records between April 2011 and April 2015 identified 250 pediatric patients who underwent single incision laparoscopic appendectomy. Of these, 137 patients underwent TULA and 113 patients underwent SILA. Measured outcomes included patients' demographics, clinical characteristics, operative time, length of stay, pain, and postoperative complications.
  
  
  RESULTS
  TULA group had a shorter operative time than SILA group (28.93 vs. 49.19min, p<0.001). The use of rescue analgesics was more frequent in the SILA group (six cases (6.5%) vs. 19 cases (23.4%), p<0.001). There was no significant difference in cosmetic outcome between the two groups. However, TULA was associated with a lower complication rate (2/137, 1.5%) than SILA (11/113, 9.8%) (p=0.0035). In multiple logistic regression analysis, TULA was significantly associated with a lower complication rate (p=0.049).
  
  
  CONCLUSIONS
  TULA is preferable to SILA for treating pediatric acute appendicitis because it is technically easier, results in better surgical outcomes, and provides the same excellent cosmetic results.
authors: Division of Pediatric Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea. Electronic address: drboo@korea.ac.kr.
authors: Yoon Jung
authors: YJ
authors: Boo
authors: Division of Pediatric Surgery, Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
authors: Yoon
authors: Y
authors: Lee
authors: Department of Medical Statistics, Clinical Research Center, Asan Medical Center, Seoul, Korea.
authors: Ji Sung
authors: JS
authors: Lee
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery
keywords: Appendectomy; Children; Laparoscopy; Single-port access; Transumbilical surgery