P1467 - Comparison of Trans Umbilical Laparoscopic-Assisted Appendectomy (TULAA) vs Conventional Laparoscopic Appendectomy (CLA) In the Pediatric Population: A Systematic Review and Meta-Analysis

Award: Presidential Poster Award

Ameer Haider Cheema, MD¹, Ayesha Ahmed, ², Muhammad Hassan Waseem, MD³, Zain Ul Abideen, ⁴, Barka Sajid, MBBS⁵, Noor Ul Huda Ramzan, MD⁶, Abdul Ahad, MBBS⁷, Sadia Tameez-ud-din, MBBS⁸, Ayesha A. Khan, MBBS⁹, Sbahat Fatima, MBBS¹⁰, Muneeba Iqbal, MBBS¹¹, Tahira Fatima, MBBS¹², Muhammad Mubashir Khan, MBBS^9
1University of Pittsburgh Medical Center - Mercy, Pittsburgh, PA; ²King Edward Medical University, Lahore, Punjab, Pakistan; ³Allama iqbal Medical College, Lahore, Punjab, Pakistan; ⁴King Edward Medical University, Faisalabad, Punjab, Pakistan; ⁵Sindh Medical College, Karachi, Sindh, Pakistan; ⁶University Medical and Dental College, Pittsburgh, PA; ⁷Khyber Medical College, Peshawar, North-West Frontier, Pakistan; ⁸Foundation University Medical College, Rawalpindi, Punjab, Pakistan; ⁹Dow Medical College, Karachi, Sindh, Pakistan; ¹⁰Karachi Medical and Dental College, Karachi, Sindh, Pakistan; ¹¹Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Sindh, Pakistan; ¹²Dow International Medical College, Karachi, Sindh, Pakistan

Introduction: Appendicitis, a pediatric emergency, is usually managed with conventional three-port laparoscopic appendectomy (CLA). Trans-umbilical Extracorporeal Laparoscopic Assisted Appendectomy 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 till May 2024. Studies comparing outcomes of trans umbilical extracorporeal laparoscopic-assisted appendectomy 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, one RCT and 15 retrospective cohort studies with 5084 patients were included in this meta-analysis. 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 hospitalstay (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 two 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%).

Discussion: 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 two groups.



Disclosures:


Ameer Haider Cheema, MD¹, Ayesha Ahmed, ², Muhammad Hassan Waseem, MD³, Zain Ul Abideen, ⁴, Barka Sajid, MBBS⁵, Noor Ul Huda Ramzan, MD⁶, Abdul Ahad, MBBS⁷, Sadia Tameez-ud-din, MBBS⁸, Ayesha A. Khan, MBBS⁹, Sbahat Fatima, MBBS¹⁰, Muneeba Iqbal, MBBS¹¹, Tahira Fatima, MBBS¹², Muhammad Mubashir Khan, MBBS⁹. P1467 - Comparison of Trans Umbilical Laparoscopic-Assisted Appendectomy (TULAA) vs Conventional Laparoscopic Appendectomy (CLA) In the Pediatric Population: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.