Subumbilical versus transumbilical laparoscopic assisted appendectomy in children: a caregivers-centered cosmetic satisfaction evaluation

BaCKgrOuND: Studies suggest that trans-umbilical incisions (Tui) incur better postoperative cosmetic satisfaction scores (CSS) than subumbilical incisions (Sui) but a higher incidence of surgical site infection (SSi). We aimed to compare these outcomes after Tui or Sui for uncomplicated pediatric appendicitis (ua). METhODS: analysis of medical records of 99 children treated at our institution for ua with Tui or Sui. Caregivers underwent a telephonic interview on postoperative course, filling in the Patient Subscale of the Patient and Observer Surgical Assessment Scale (POSAS) version 2.0 – POSaS v. 2.0. rESuLTS: Of 99 eligible patients, 67 participated to the study (12 Sui and 55 Tui). groups were similar for age, sex, BMi, histology of the appendix, incidence of granuloma. Compared to Sui group, Tui group presented shorter operative time (min 87.5±51.41 Sui; 69.43±22.07 Tui. P=0.059), postoperative hospitalization (days, 3.3±1.1 vs. 4±1.84), lower rate of SSi (2/55 vs. 2/12) and lower POSaS Score (11.32±7.65 vs. 14.25±9.2), even if statistically insignificant. A positive overall opinion in both groups was reported (TUI vs. Sui: 2.13±2 vs. 2.5±2, respectively, P=ns). CONCLuSiONS: Tui seems to be preferable over Sui as approach for ua, but larger prospective series are needed to validate these results.