Laparoscopic appendectomy in paediatric patients: optimization with a new method of port insertion

Conventional methods of port insertion for laparoscopic appendectomy often result in poor surgical access, especially when a pelvic appendix is encountered or when mobilization of the caecum becomes necessary. The relatively small antero-posterior diameter of the peritoneal cavity in children further aggravates this problem.

We have modified the procedure by inserting only one 10-mm port at the sub-umbilical position, and two 5-mm ports at the lower abdomen beneath the 'bikini line'. The videoscope is inserted via the left lower abdominal port, and the sub-umbilical port and the right lower abdominal port are used as the working ports.

Very satisfactory results have been achieved. The bottom of the caecum can be well visualized and caecum mobilization becomes easy. A pelvic appendix is well visualized. Dissection of a high retrocaecal appendix could be carried out without being obscured by the caecum. Better cosmetic results were also achieved. The method has been applied in 66 patients (aged 4-14). The mean operation time was 62 min.

We recommend this approach to be used as the standard procedure for laparoscopic appendectomy in children.