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

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

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