One-Port Laparoscopy-Assisted Appendectomy in Children with Appendicitis: Experience with 100 Cases

Abstract

Purpose

: We describe our technique for laparoscopic appendectomy via a single umbilical incision (one-port method).

Patients and Methods

: One hundred children with acute appendicitis were operated on using this method. Two, both of whom had pelvic abscesses, required conversion to open appendectomy.

Results

: There were neither immediate nor late complications. The operating time was 15 to 130 minutes, with an average of 45 minutes. The histologic findings were appendicitis of the catarrhal type in 12 cases, of the phlegmonous type in 42, and of the gangrenous type in 46. Twenty-six cases were associated with pelvic abscesses. The patients were discharged within 2 to 17 days. The umbilical incision was invisible at 3 months.

Conclusions

: The key point of this technique is that the abdominal lift must be released and the abdomen deflated before the appendix is delivered through the umbilical incision, because the abdominal cavity is deep. Without release of the Laparolift, delivery of the appendix is difficult. When the appendix wall is weak and the mesoappendix is shortened by severe inflammation, the cecum or base of the appendix to which inflammation has not yet been spread must be grasped. If considerable difficulty is encountered in delivering the appendix, it is not necessary to pull the appendix by force. First, the base of the appendix, which must be tied and divided just under the umbilical incision, is held intracorporeally under direct vision. Then the appendix can be freed and delivered through the umbilical incision. As the appendectomy is performed under direct vision, it is possible to tie the appendix and to invert the stump using a pursestring suture as in traditional open methods.