Page 86 - World Journal of Laparoscopic Surgery

CLINICAL TECHNIQUE
Scarless Appendectomy in Children. Is it Safe? Our Initial

Single-center Experience

3
2
1
Rezkalla Akkary , Jinane G Doumat , Loic H Jochault , Sandy F Jochault-Ritz 4
Received on: 04 May 2021; Accepted on: 06 September 2022; Published on: 07 December 2022
AbstrAct
Purpose: Since the description of laparoscopic appendectomy, the surgeons are trying to develop techniques using less incisions. We describe
our initial experience with the transumbilical laparoscopic-assisted appendectomy (TULAA) in children.
Materials and methods: A prospective, single surgeon, single-center study was conducted. The technique was described (Video). The rates of
conversion of intraoperative complications and of postoperative complications were noted. Risk factors for conversion were analyzed.
Results: Forty patients were included. Conversion to a classical 3-port technique was done in 13 cases. The only intraoperative complication
was an epiploic bleeding encountered in 1 patient. The only postoperative complication was an umbilical abscess in 2 patients. A scarless
abdomen was noted 1 month postoperatively.
Conclusion: Transumbilical laparoscopic-assisted appendectomy had combined the exposure advantages of laparoscopy and the low cost of
open surgery. Despite the small population number, it seems to be safe, reproducible, and effective, and it had superior esthetic advantages.
Clinical significance: Trans-umbilical laparoscopic-assisted appendectomy reduces the incisions needed to do an appendectomy with no
increased risk in complications when compared to the traditional techniques.
Keywords: Appendectomy, Laparoscopy, Single trocar surgery.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1518

IntroductIon 1 University of Strasbourg, Strasbourg, Alsace, France; Hopitaux Civils
1
Open appendectomy, first described in the 19th century, remained De Colmar, Colmar, Haut-Rhin, France
the treatment of choice of appendicitis till the introduction of 2 Department of Medical Biology, Saint Joseph Hospital, Paris, France
2
laparoscopic appendectomy. Many innovative minimal invasive 3 Department of Public Health, Colmar Civilian Hospital, Colmar, Alsace,
3,4
techniques have been developed, trying to decrease the number France
of ports used in the classical 3-port laparoscopic technique. The 4 Department of Pediatric Surgery, Colmar Civilian Hospital, Colmar,
trans-umbilical single incision laparoscopic appendectomy uses Alsace, France
the minimum of laparoscopic instruments for the exposure, Corresponding Author: Sandy F Jochault-Ritz, Department of
and appendectomy is done extracorporeally like in the open Pediatric Surgery, Colmar Civilian Hospital, Colmar, Alsace, France,
5,6
technique. Transumbilical laparoscopic-assisted appendectomy Phone: +0033682041857, e-mail: sandy.jochault-ritz@ch-colmar.fr
thus combines the advantageous exposure of laparoscopy and How to cite this article: Akkary R, Doumat JG, Jochault LH, et al.
7
the low cost of open surgery. Once a new surgical technique is Scarless Appendectomy in Children. Is it Safe? Our Initial Single-center
adopted, assuring the safety of the technique during the learning Experience. World J Lap Surg 2022;15(3):272–275.
8
phase might be challenging. In this paper, we described the initial Source of support: Nil
experience of one surgeon started adopting the TULAA. The aim Conflict of interest: None
was to highlight a simple and reproducible technique, that was
forgotten. We described the technique, its advantages, and its
limitations. We analyzed the children operated using this technique they were operated according to TULAA. All other patients were
and their complications. operated according to TULAA. Only patients operated primarily
according to TULLA were included. The operative time (OT)
MAterIAls And Methods was noted. The rate of conversion was calculated. Conversion
All pediatric patients (age ≤18 years) operated for appendicitis was either to the classical 3-port approach or to laparotomy.
by a single surgeon in a single center between November 2018 Risk factors for conversion were identified. Intraoperative
and October 2019 were prospectively studied. Upon patient complications like intestinal perforation and bleeding were
presentation, all patients had a basic blood work out and reported. Length of stay (LOS) was studied. Patients were followed
abdominal echography. CT scanner was not done. Patients with till March 2021. Follow-up was done clinically. Postoperative
a preoperative suspicion of generalized peritonitis on the initial complications, like intra-abdominal abscess, skin infection,
evaluation were directly operated by a classic 3-port approach, intestinal obstruction, and incisional hernia were reported. All
so TULAA was not attempted, and hence they were excluded. All parents were educated about the small but still existing risk of
patients with appendicular phlegmon or abscess on the initial intestinal obstruction.
evaluation were treated medically. After a 10 weeks interval, The technique of TULAA (Video 1).

© The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.