Reduced Nursing Burden and Enhanced Recovery: Gasless Single-Port Transumbilical Extracorporeal Laparoscopic-Assisted Versus Conventional Laparoscopic Appendectomy in Children

Abstract

Background:

Laparoscopic appendectomy represents the standard of care for pediatric acute appendicitis. However, conventional techniques utilizing CO₂ pneumoperitoneum introduce physiological disturbances that may increase postoperative care requirements. The gasless single-port transumbilical extracorporeal approach (gasless-TULAA) eliminates pneumoperitoneum-related complications, yet its impact on nursing workload and recovery dynamics remains systematically unexamined in pediatric populations.

Objective:

To compare the effects of gasless-TULAA versus conventional laparoscopic appendectomy (CLA) on postoperative nursing burden and recovery outcomes in pediatric patients.

Methods:

A retrospective cohort study was conducted involving 266 pediatric patients with uncomplicated acute appendicitis at a single tertiary center between January 2022 and March 2025. Patients were allocated to either gasless-TULAA (n = 101) or CLA (n = 165). The primary endpoints were the frequency of postoperative nursing interventions and time to first ambulation and bowel function recovery. Secondary outcomes included postoperative pain scores, complication rates, length of hospital stay, direct hospitalization costs, and cosmetic satisfaction.

Results:

The gasless-TULAA group demonstrated significantly reduced nursing interventions (mean 2.17 ± 2.10 versus 2.74 ± 1.93, P = .029), shorter time to first ambulation (7.72 ± 1.20 hours versus 11.69 ± 2.06 hours, P < .001), and faster bowel recovery (10.30 ± 4.03 hours versus 11.64 ± 5.08 hours, P = .025). Postoperative pain scores were lower (median Numeric Rating Scale score 2 versus 3, P = .002), costs were reduced (944.41 ± 254.11 USD versus 1032.77 ± 223.34 USD, P = .004), and cosmesis satisfaction was higher (9.05 ± 0.73 versus 8.00 ± 0.92, P < .001). Complication rates did not differ (9.8% versus 10.2%, P = .902).

Conclusion:

Gasless-TULAA significantly reduces nursing burden and accelerates recovery compared with CLA, without compromising safety, supporting its integration to optimize perioperative care efficiency in pediatric surgery.