S2130 Comparison of Trans Umbilical Laparoscopic-Assisted Appendectomy (TULAA) vs Conventional Laparoscopic Appendectomy (CLA) In the Pediatric Population: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Appendicitis, a pediatric emergency, is usually managed with conventional 3-port laparoscopic appendectomy (CLA). Trans-umbilical extracorporeal laparoscopic assisted appendectomy (TULAA) offers a novel approach, matching CLA's benefits while enhancing cosmetic results. This study evaluates the safety and efficacy of TULAA compared to CLA in children to identify the optimal surgical method. Methods: We searched PubMed, Cochrane Library (CENTRAL), ScienceDirect, and ClinicalTrials.gov databases from inception to May 2024. Studies comparing outcomes of TULAA and conventional laparoscopic appendectomy in pediatric patients aged 0-18 years were included. We used RevMan 5.4.1 software to combine mean differences (MD) and risk ratios (RR) for continuous and dichotomous outcomes, respectively, with a 95% confidence interval (CI) using the random effects model. Sensitivity analysis was conducted for outcomes with heterogeneity exceeding I2 = 50%. Quality assessment was done using the Newcastle-Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool (Rob 2.0) and the risk of publication bias in the included studies was assessed through funnel plots and Egger’s regression test. Results: A total of 16 studies, 1 randomized controlled trial and 15 retrospective cohort studies with 5,084 patients were included in this meta-analysis (Table 1). TULAA was significantly superior to CLA in terms of operating time (OT) (MD = -11.16 min, 95% CI: [-14.84, -7.47]; P = 0.00001; I2 = 95%), length of hospital stay (LOS) (MD = -0.44 days, 95% CI: [-0.71, -0.17]; P=0.002; I2 = 91%), and intraabdominal infections (RR = 0.64, 95% CI: [0.43,0.96]; P = 0.03; I2 = 0%). TULAA was also associated withan increased requirement of additional ports (RR= 32.22, 95% CI: [10.11,102.70]; P= 0.00001; I2 = 0%) while the 2 groups were comparable in terms of wound infection (RR = 1.11, 95% CI: [0.68,1.79]; P = 0.68; I2 = 12%), ileus (RR = 0.71, 95% CI: [0.33,1.53]; P = 0.38; I2 = 0%), conversion rate to open appendectomy (RR= 2.77, 95% CI: [0.86,8.89]; P = 0.09, I2 = 77%) and readmission rate (RR= 0.73, 95% CI: [0.33,1.61]; P = 0.43; I2 = 33%) (Figure 1). Conclusion: TULAA shows promising results in treating pediatric appendicitis. TULAA outperformed CLA in terms of operating time, length of hospital stays, and intraabdominal infection. There was no significant difference in terms of wound infection, ileus, conversion rate and readmission between the 2 groups.Figure 1.: A. Operating time. B. Length of hospital stay. C. Wound infection D. Intra abdominal infections (abscess). Table 1. - Studies included Author Study Design Duration (year, month) Participants Country Mean age in years(SD) Gender, n (M/F) Weight or BMI kg/m2 (SD) Complicated appendicits n%(TULAA/CLA) NOS TULA CLA TULA CLA Go 2016 RC (4,0) 303 Korea 9.02(2.28) 9.64(2.14) 187/116 - - 0/0 8 Stanfill 2010 RC (2,11) 131 United States 10.45(0.65) 11.51(0.93) 88/43 - - 11/14 8 Sekioka 2018 RC (9,0) 262 - 10.6(4.6-16.3)* 10.1(3.2-15)* 88/33 32.2(14-62) 33.3(14.2-58.7) 81/60 7 Nishida 2024 RC (6,8) 225 Japan 10.1(2.8) 9.9(2.6) 133/92 34.4(13) 34.4(12.8) 33/28 8 Kulyalat 2014 RC (2,10) 433 United States 9.4(3.3) 10.1(3.8) 230/142 - - 13/55 7 Chang 2020 RC (4,5) 315 Taiwan 11.8(3.4) 10.5(4.3) 101/53 - - 12/62 8 Deie 2013 RC (3,4) 88 - 10.3(2.6) 10.5(2.76) 55/33 32.3(9.75) 33.7(11.3) 31/44 6 Karam 2016 RC (5,11) 625 - 10.63(3.7) 11(3.2) 389/236 52.15(24.42) 65.09(20) 46/122 6 Rebecca 2023 RC (5,2) 1154 United States 10.3(3.5) 11.2(3.7) 724/430 19.2(4.1) 21.4(6.1) 0/0 8 Bindi 2023 RC (1,11) 181 - 10.7(0.6) 9.2(0.4) - 36.2(1.5) 32.9(1.8) 136/79 7 Bergholz 2014 RC - 20 Germany 12.42(10.13-14.11)* 12.93(11.25-14.62)* 8/32 - - 2/4 8 Wieck 2016 RC (5,0) 337 Portland 10(4.1) 10.2(3.8) 192/145 19.3(4.4) 20(1.1) 40/80 7 Martin 2017 RC (12,3) 460 Spain 122.8(35.8) 123(33.9) 294/166 39.4(29.7) 37.6(16.5) 136/9 7 Vejdan 2021 RCT (1,4) 210 Iran 12.32(2.14) 11.43.32(2.76) 73/67 17.35(3.12) 17.92(2.43) 0/0 Low* Visnijic 2007 RC (3,0) 72 Croatia - - - - - 0/0 8 He 2022 RC (3,9) 268 China 11.3(3.4) 10.6(3.2) 129/139 16.5(2.2) 16.8(2) 0/0 8 CLA, conventional laproscopic appendectomy; NOS, Newcastle-Ottawa Scale; RC, retrospective cohort; RCT: randomized control trial; TULA, transumbilical laproscopic assisted appendectomy.*median(range).**ROB 2.0 assessment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.036 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".