The advantages of the three-port combined technique for laparoscopically assisted extracorporeal base ligationin appendicitis in children

Background: Laparoscopic appendectomy is the treatment of choice for acute appendicitis. The optimal technique of appendiceal stump closure is still under discussion because it is assumed to affect the occurrence of complications. The three-port combined technique with laparoscopically assisted extracorporeal base ligation (mesoappendix hemostasis performed intra-abdominally and the appendix ligated extra-abdominally) represents a novel technique with which to ligate the appendiceal stump following laparoscopic appendectomy. We compared this combined technique with the appendix stump treatment technique using an endoscopic loop, for complicated and uncomplicated appendicitis. Material and methods: In the period from January 1, 2020 to December 31, 2024, 628 patients under the age of 18 were operated on for appendicitis at the Clinic for Pediatric Surgery of the Clinical Center of the University of Sarajevo, 430(68.5%) with open appendectomy and 198(31,5%) with laparoscopic appendectomy We divided all the patients intotwo groups, group A with 102 patients who underwent surgery with a combined laparoscopic method, and group B where the base of the appendix was closed with an endoscopic loop (95 patients).Results: 198 patients underwent laparoscopic surgery, of which 123 (62%) were boys and 75 (38%) girls. Of these 198 patients who underwent laparoscopic surgery, 102 (52%) were treated using laparoscopically assisted extracorporeal ligation of the base of the appendix, 80 (40%) patients with one endoloop, 15 (8%) with 2 endoloops and only one patient with 1(0.5%) hem-o-lok and an endoloop. Of the 198 patients who were operated laparoscopically, 108 (54%) had complicated appendicitis, 59 (30%) uncomplicated appendicitis and 31 (16%) chronic appendicitis. The average duration of surgery for patients treated with the combined method was 58.61 minutes and with endoscopic loops 69.41 minutes. The average length of hospitalization for patients treated with the combined method was 3.96 days and with endoscopic loops 4.59 days.Conclusions: The three-port combined technique for laparoscopically assisted extracorporeal base ligation of the appendix is a safe, useful, and cost-effective alternative to endoscopic loops, with the advantages of less manipulation, fewer complications involving the appendix, and shorter operative times. This technique is particularly acceptable in resource-limited countries.