Umbilical one-puncture laparoscopic-assisted appendectomy in children.

To perform a laparoscopic appendectomy, three trocars are usually needed. In order to reduce abdominal wall trauma, we have adopted an umbilical one-puncture laparoscopic-assisted appendectomy (UOPLAA). We did a retrospective study of UOPLAA performed during last 2 years on 200 children aged from 5 to 18 years (median, 9 years). The patients were selected after clinical examination. No child with advanced generalized peritonitis or an abscess with a palpable mass was a candidate for this technique. UOPLAA was successful in 184 patients (92%). In 16 cases (8%), an additional trocar was required to manage perforated or retrocecal appendicitis. The mean operative time was 15 min, and the mean hospital stay was 2 days. There were no intraoperative complications. There were 10 (5%) postoperative complications (three parietal and seven intraabdominal). Four patients (2%) needed reoperation under general anesthesia. The UOPLAA is our preference in cases of acute nonperforated appendicitis because it is simple and fast, with good cosmetic results; but in 8% of our cases, an intraoperative difficulty (retrocecal location, abnormal adhesive band, peritonitis, etc.) arose that required the introduction of additional devices to ensure the safety of the laparoscopic procedure.

Is diffuse xanthogranulomatous pyelonephritis a contraindication to retroperitoneoscopic nephroureterectomy? A case report.

Diffuse xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic infection of the child's kidney. The clinical presentation is nonspecific, and investigation often reveals a nonfunctional kidney. Preoperative diagnosis is very difficult even with ultrasonography and computed tomography. Total nephrectomy is the treatment of choice, but it is considered very difficult and is usually contraindicated for laparoscopic or retroperitoneoscopic techniques. Reported here is a case of retroperitoneal laparoscopic nephroureterectomy for XGP.