Key words: Acute appendicitis, Transumelical laparoscopic approach, Case series, Children
Background - Acute appendicitis is a flogistic process that is often observed in the paediatric population. The reason could be found in the over activity of the lymphatic tissue against inflammatory agents. The experience of the Paediatric Surgery Unit in Rimini (Italy) in the treatment of acute appendicitis using the transumbilical laparoscopic assisted approach (TULAA) is reported. Material and Methods -In the last 9 years, 722 children affected by acute appendicitis have been treated in the Unit using the single port access. A Hasson trocar is positioned through the umbilicus and an operative instrument is inserted through the trocar inside the abdominal cavity. Once identified, the appendix is exteriorized through the umbilicus and a traditional appendectomy is performed. Results - Out of 722 appendectomies performed, 2.7% were normal appendix (no inflammatory process in pathologic diagnosis), 17.7% were catarrhalis, 47.8% phlegmonous and 31.8% complicated appendicitis. In the last group it was necessary to widen the surgical umbilical incision of about 1-2 cm. In 3 cases (0.4%) a surgical conversion was necessary due to a reduced mobility of the appendix and caecum. Discussion - The TULAA procedure actually represents an easy and feasible technique that well combines the laparoscopic advantages with the open surgery features and excellent cosmetic results.
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