Feasibility of gasless laparoscopy-assisted transumbilical appendectomy: early experience

In recent years, single-incision laparoscopic appendectomy has been used as an improved form of conventional laparoscopic appendectomy (CLA). We have started to perform gasless laparoscopy-assisted transumbilical appendectomy (GLATUA) in patients with uncomplicated appendicitis. This study aimed to evaluate the feasibility, safety, cosmetic results, and cost-effectiveness of this novel technique of GLATUA.

In total, 30 patients with a diagnosis of acute appendicitis without evidence of periappendiceal abcess or perforation and indicated for operation were enrolled in the study. Attempts to operate by the GLATUA technique initially were made in all of the patients. When it was technically difficult to perform appendix extraction via the umbilicus, the procedures were converted to the CLA technique (conversion group). The following factors between the successful group and conversion group were investigated to evaluate feasibility and predictable factors for the success of GLATUA: age, gender, duration from symptom onset to hospital visit, preoperative ileus, preoperative white blood cell count, neutrophil count (%), body mass index, fat infiltration in abdominal computed tomography or ultrasonography, pathologic characteristics of the resected appendix, and postoperative complications.

Among the 30 patients, 19 patients underwent operation by the GLATUA technique (63.3%). There were no significant differences between the two groups in terms of demographics, duration from symptom onset to hospital visit, preoperative white blood cell count, neutrophil count (%), and pathologic characteristics of the appendix. Significant differences were observed between the two groups for preoperative ileus in simple abdominal x-ray and fat infiltration in preoperative diagnostic modality. There were no postoperative complications in both groups.

GLATUA is a feasible, safe, and cost-effective technique for appendectomy in uncomplicated appendicitis and shows good cosmetic results. It did not increase the rate of complications and represents a possible alternative to the CLA technique in cases without fat infiltration in abdominal tomography or ultrasonography and small bowel ileus in simple abdominal x-ray.