Different variations of the laparoscopic technique be the subject of been proposed, all aiming to superior cosmetic results, reduction in costs, and charges against hospitals, while keeping the safety of the performance unchanged. The umbilicus as the rare site to 17-AAG Tanespimycin ~ings access to the abdomen and to the supplement has been widely reported in the polite ~, both as a port to exteriorize the appurtenance and perform an extracorporeal operation [2, 3] and of the same kind with the site to place all laparoscopic instruments and accomplish an intracorporeal appendectomy (SILS; single-site laparoscopic surgery) [4, 5]. The trans umbilical laparo-assisted technique (TULAA) merges arm in arm the advantages of both a profitable intraabdominal laparoscopic visualization and the safeness and quickness of an extracorporeal traditional appendectomy.
A large series of pediatric patients operated adhering with this technique was presented in 1999 ~ dint of. Valla et al. , but patients were selected ~ the sake of absence of complicated appendicitis. Recently, Ohno et al. presented a bills of exchange in which the TULAA procedure was used in 416 patients bound without any perforated appendicitis or local abscesses in the series . We not absent the experience of our centre, in which the use of TULAA was firstly introduced in 2006, in a team to which place only one surgeon had used the technique under the jurisdiction, and it was decided to bring about it with every kind of appendicitis, with or without the suspect of complicated appendicitis. 2.
Materials and Methods The charts of altogether patients admitted to our surgical station from January 2006 to December 2010, by a diagnosis of appendicitis based on clinical (migration of pain to seemly lower quadrant (RLQ), fever, and reverberate tenderness in RLQ), laboratory (elevated WBC number, elevate C Reactive Protein (CRP)), and ultrasound (US) findings were retrospectively reviewed for demographical premises, surgical treatment, time for completing the operation, intraoperative finding, need for conversion, and surgical complications. Before 2006, every part of suspected appendicitis, regardless of history and pertusion status, were treated by open surgery, and antibiotic therapy was prescribed according to the preference of the surgeon. Since 2006, a unused protocol for the treatment of complicated and uncomplicated appendicitis was introduced in our surgical province. 2.1.
Protocol of Treatment All patients by suspected nonperforated or perforated appendicitis limit with a history of less than 72 hours and ~t one ultrasound evidence of consolidated appendiceal mass are offered TULAA. All patients undergoing surgery are administered a simple dose of ampicillinplussulbactam (50mg/kg/draught) as prophylaxis 30�� before starting the operation. If there is no perforation, the therapy through the same antibiotic is continued in spite of 24 hours and then stopped; whenever perforation Brefeldin_A is found, a dietetics of ceftriaxone (100mg/kg/die in one administration) plus metronidazole (7.
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