Transumbilical laparoscopic-assisted appendectomy: a feasible minimally invasive option for pediatric acute appendicitis with comparable outcomes to three-port laparoscopic appendectomy

Objective This study aimed to compare the safety and feasibility of transumbilical laparoscopic-assisted appendectomy (TULAA) vs. three-port laparoscopic appendectomy (TPLA) for the treatment of acute appendicitis in children. Materials and methods A retrospective analysis was conducted on pediatric patients who underwent appendectomy at Maternity&Child Healthcare Hospital of Longgang District, Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College) between January 2022 and June 2025. Patient demographics, operative times, postoperative recovery parameters (time to first flatus, length of hospital stay), and complication rates were compared between the two surgical groups. Results A total of 171 patients were enrolled in the study, with 109 cases in the TULAA group and 62 cases in the TPLA group. There were no significant differences between the TULAA and TPLA groups in baseline characteristics including age, gender, weight, height, BMI, white blood cell count, or CRP levels ( p > 0.05). The mean operative time was comparable between groups (TULAA: 54.94 ± 24.97 min vs. TPLA: 58.65 ± 25.58 min, p = 0.356). However, the TULAA group demonstrated a significantly shorter average hospital stay (4.83 ± 1.53 days vs. 5.35 ± 1.19 days, p = 0.022). Conversely, the time to first postoperative flatus was significantly longer in the TULAA group (25.81 ± 11.00 h vs. 21.13 ± 10.01 h, p = 0.006). The overall complication rate showed no significant difference (TULAA: 4.6% vs. TPLA: 6.5%, p > 0.05), with all cases managed conservatively. Conclusion For pediatric acute appendicitis, TULAA is a safe and feasible minimally invasive technique, resulting in a significantly reduced hospital stay compared to TPLA despite a slightly delayed return of bowel function. Both techniques demonstrate comparable operative times and overall complication rates. TULAA represents a valuable surgical option within the pediatric minimally invasive arsenal.