Transumbilical laparoscopic-assisted appendectomy in children: Clinical and surgical outcomes
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摘要
The aim of this paper is to present and describe tran-sumbilical laparoscopic-assisted appendectomy in chil-dren, focusing on its technical aspects and clinical andsurgical outcomes. The surgical charts of all patientsaged between 0 and 14 years treated with transumbili-cal laparoscopic-assisted appendectomy admitted tothe authors' institution from January 2009 to Septem-ber 2013 with a diagnosis of suspected appendicitis fol-lowing clinical, laboratory and ultrasound findings werereviewed. Operating time, intraoperative findings, needfor conversion or for additional trocars, and surgicacomplications were reported. During the study period,120 patients aged between 6 and 14 years(mean age:9.9 years), 73 females(61%) and 47 males(39%),were treated with transumbilical laparoscopic-assistedappendectomy. There were 37 cases of hyperemicappendicitis(subserosal and retrocecal), 74 cases ofphlegmonous appendicitis and 9 cases of perforatedgangrenous appendicitis. It was not possible to estab-lish a correlation between grade of appendicitis andmean operating time(P > 0.05). Eleven cases(9%)needed the use of one additional trocar, while 8 pa-tients(6%) required conversion to the standard laparo-scopic technique with the use of two additional trocars. No patient was converted to the open technique. Tran-sumbilical laparoscopic-assisted appendectomy is a safe technique in children and it could be used by surgeons who want to approach other minimally invasive tech-niques.
The aim of this paper is to present and describe tran-sumbilical laparoscopic-assisted appendectomy in chil-dren, focusing on its technical aspects and clinical andsurgical outcomes. The surgical charts of all patientsaged between 0 and 14 years treated with transumbili-cal laparoscopic-assisted appendectomy admitted tothe authors' institution from January 2009 to Septem-ber 2013 with a diagnosis of suspected appendicitis fol-lowing clinical, laboratory and ultrasound findings werereviewed. Operating time, intraoperative findings, needfor conversion or for additional trocars, and surgicacomplications were reported. During the study period,120 patients aged between 6 and 14 years(mean age:9.9 years), 73 females(61%) and 47 males(39%),were treated with transumbilical laparoscopic-assistedappendectomy. There were 37 cases of hyperemicappendicitis(subserosal and retrocecal), 74 cases ofphlegmonous appendicitis and 9 cases of perforatedgangrenous appendicitis. It was not possible to estab-lish a correlation between grade of appendicitis andmean operating time(P > 0.05). Eleven cases(9%)needed the use of one additional trocar, while 8 pa-tients(6%) required conversion to the standard laparo-scopic technique with the use of two additional trocars. No patient was converted to the open technique. Tran-sumbilical laparoscopic-assisted appendectomy is a safe technique in children and it could be used by surgeons who want to approach other minimally invasive tech-niques.
The aim of this paper is to present and describe tran-sumbilical laparoscopic-assisted appendectomy in chil-dren, focusing on its technical aspects and clinical andsurgical outcomes. The surgical charts of all patientsaged between 0 and 14 years treated with transumbili-cal laparoscopic-assisted appendectomy admitted tothe authors' institution from January 2009 to Septem-ber 2013 with a diagnosis of suspected appendicitis fol-lowing clinical, laboratory and ultrasound findings werereviewed. Operating time, intraoperative findings, needfor conversion or for additional trocars, and surgicacomplications were reported. During the study period,120 patients aged between 6 and 14 years(mean age:9.9 years), 73 females(61%) and 47 males(39%),were treated with transumbilical laparoscopic-assistedappendectomy. There were 37 cases of hyperemicappendicitis(subserosal and retrocecal), 74 cases ofphlegmonous appendicitis and 9 cases of perforatedgangrenous appendicitis. It was not possible to estab-lish a correlation between grade of appendicitis andmean operating time(P > 0.05). Eleven cases(9%)needed the use of one additional trocar, while 8 pa-tients(6%) required conversion to the standard laparo-scopic technique with the use of two additional trocars. No patient was converted to the open technique. Tran-sumbilical laparoscopic-assisted appendectomy is a safe technique in children and it could be used by surgeons who want to approach other minimally invasive tech-niques.
引文
1 Carus T.Current advances in single-port laparoscopic surgery.Langenbecks Arch Surg 2013;398:925-929[PMID:24037311 DOI:10.1007/s00423-013-1113-2]
2 Stephens PL,Mazzucco JJ.Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis.Conn Med 1999;63:137-140[PMID:10218289]
3 Brennan GD.Pediatric appendicitis:pathophysiology and appropriate use of diagnostic imaging.CJEM 2006;8:425-432[PMID:17209492]
4 Graham JM,Pokorny WJ,Harberg FJ.Acute appendicitis in preschool age children.Am J Surg 1980;139:247-250[PMID:7356110 DOI:10.1016/0002-9610(80)90265-2]
5 el Ghoneimi A,Valla JS,Limonne B,Valla V,Montupet P,Chavrier Y,Grinda A.Laparoscopic appendectomy in chil-dren:report of 1,379 cases.J Pediatr Surg 1994;29:786-789[PMID:8078022 DOI:10.1016/0022-3468(94)90371-9]
6 Valla JS,Limonne B,Valla V,Montupet P,Daoud N,Grinda A,Chavrier Y.Laparoscopic appendectomy in children:re-port of 465 cases.Surg Laparosc Endosc 1991;1:166-172[PMID:1669397]
7 Ohno Y,Morimura T,Hayashi S.Transumbilical laparo-scopically assisted appendectomy in children:the results of a single-port,single-channel procedure.Surg Endosc 2012;26:523-527[PMID:21938576 DOI:10.1007/s00464-011-1912-x]
8 de Armas IA,Garcia I,Pimpalwar A.Laparoscopic single port surgery in children using Triport:our early experience.Pediatr Surg Int 2011;27:985-989[PMID:21461884 DOI:10.1007/s00383-011-2892-6]
9 Amos SE,Shuo-Dong W,Fan Y,Tian Y,Chen CC.Single-incision versus conventional three-incision laparoscopic ap-pendectomy:a single centre experience.Surg Today 2012;42:542-546[PMID:22218872 DOI:10.1007/s00595-011-0110-8]
10 Lima GJ,Silva AL,Leite RF,Abras GM,Castro EG,Pires LJ.Transumbilical laparoscopic assisted appendectomy compared with laparoscopic and laparotomic approaches in acute appendicitis.Arq Bras Cir Dig 2012;25:2-8[PMID:22569970]
11 Valla J,Ordorica-Flores RM,Steyaert H,Merrot T,Bartels A,Breaud J,Ginier C,Cheli M.Umbilical one-puncture laparo-scopic-assisted appendectomy in children.Surg Endosc 1999;13:83-85[PMID:9869698 DOI:10.1007/s004649900906]
12 Shekherdimian S,DeUgarte D.Transumbilical laparoscop-ic-assisted appendectomy:an extracorporeal single-incision alternative to conventional laparoscopic techniques.Am Surg 2011;77:557-560[PMID:21679587]
13 Kagawa Y,Hata S,Shimizu J,Sekimoto M,Mori M.Tran-sumbilical laparoscopic-assisted appendectomy for children and adults.Int J Colorectal Dis 2012;27:411-413[PMID:21538051 DOI:10.1007/s00384-011-1226-4]
14 Sesia SB,Haecker FM,Kubiak R,Mayr J.Laparoscopy-assisted single-port appendectomy in children:is the postop-erative infectious complication rate different?J Laparoendosc Adv Surg Tech A 2010;20:867-871[PMID:20879873 DOI:10.1089/lap.2010.0180]
15 Stanfill AB,Matilsky DK,Kalvakuri K,Pearl RH,Wallace LJ,Vegunta RK.Transumbilical laparoscopically assisted appendectomy:an alternative minimally invasive technique in pediatric patients.J Laparoendosc Adv Surg Tech A 2010;20:873-876[PMID:20874231 DOI:10.1089/lap.2010.0147]
16 Koontz CS,Smith LA,Burkholder HC,Higdon K,Aderhold R,Carr M.Video-assisted transumbilical appendectomy in children.J Pediatr Surg 2006;41:710-712[PMID:16567181 DOI:10.1016/j.jpedsurg.2005.12.014]
2 Stephens PL,Mazzucco JJ.Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis.Conn Med 1999;63:137-140[PMID:10218289]
3 Brennan GD.Pediatric appendicitis:pathophysiology and appropriate use of diagnostic imaging.CJEM 2006;8:425-432[PMID:17209492]
4 Graham JM,Pokorny WJ,Harberg FJ.Acute appendicitis in preschool age children.Am J Surg 1980;139:247-250[PMID:7356110 DOI:10.1016/0002-9610(80)90265-2]
5 el Ghoneimi A,Valla JS,Limonne B,Valla V,Montupet P,Chavrier Y,Grinda A.Laparoscopic appendectomy in chil-dren:report of 1,379 cases.J Pediatr Surg 1994;29:786-789[PMID:8078022 DOI:10.1016/0022-3468(94)90371-9]
6 Valla JS,Limonne B,Valla V,Montupet P,Daoud N,Grinda A,Chavrier Y.Laparoscopic appendectomy in children:re-port of 465 cases.Surg Laparosc Endosc 1991;1:166-172[PMID:1669397]
7 Ohno Y,Morimura T,Hayashi S.Transumbilical laparo-scopically assisted appendectomy in children:the results of a single-port,single-channel procedure.Surg Endosc 2012;26:523-527[PMID:21938576 DOI:10.1007/s00464-011-1912-x]
8 de Armas IA,Garcia I,Pimpalwar A.Laparoscopic single port surgery in children using Triport:our early experience.Pediatr Surg Int 2011;27:985-989[PMID:21461884 DOI:10.1007/s00383-011-2892-6]
9 Amos SE,Shuo-Dong W,Fan Y,Tian Y,Chen CC.Single-incision versus conventional three-incision laparoscopic ap-pendectomy:a single centre experience.Surg Today 2012;42:542-546[PMID:22218872 DOI:10.1007/s00595-011-0110-8]
10 Lima GJ,Silva AL,Leite RF,Abras GM,Castro EG,Pires LJ.Transumbilical laparoscopic assisted appendectomy compared with laparoscopic and laparotomic approaches in acute appendicitis.Arq Bras Cir Dig 2012;25:2-8[PMID:22569970]
11 Valla J,Ordorica-Flores RM,Steyaert H,Merrot T,Bartels A,Breaud J,Ginier C,Cheli M.Umbilical one-puncture laparo-scopic-assisted appendectomy in children.Surg Endosc 1999;13:83-85[PMID:9869698 DOI:10.1007/s004649900906]
12 Shekherdimian S,DeUgarte D.Transumbilical laparoscop-ic-assisted appendectomy:an extracorporeal single-incision alternative to conventional laparoscopic techniques.Am Surg 2011;77:557-560[PMID:21679587]
13 Kagawa Y,Hata S,Shimizu J,Sekimoto M,Mori M.Tran-sumbilical laparoscopic-assisted appendectomy for children and adults.Int J Colorectal Dis 2012;27:411-413[PMID:21538051 DOI:10.1007/s00384-011-1226-4]
14 Sesia SB,Haecker FM,Kubiak R,Mayr J.Laparoscopy-assisted single-port appendectomy in children:is the postop-erative infectious complication rate different?J Laparoendosc Adv Surg Tech A 2010;20:867-871[PMID:20879873 DOI:10.1089/lap.2010.0180]
15 Stanfill AB,Matilsky DK,Kalvakuri K,Pearl RH,Wallace LJ,Vegunta RK.Transumbilical laparoscopically assisted appendectomy:an alternative minimally invasive technique in pediatric patients.J Laparoendosc Adv Surg Tech A 2010;20:873-876[PMID:20874231 DOI:10.1089/lap.2010.0147]
16 Koontz CS,Smith LA,Burkholder HC,Higdon K,Aderhold R,Carr M.Video-assisted transumbilical appendectomy in children.J Pediatr Surg 2006;41:710-712[PMID:16567181 DOI:10.1016/j.jpedsurg.2005.12.014]