Associations Between Sonographic Findings and Operative Time of Transumbilical Laparoscopic-Assisted Appendectomy for Acute Appendicitis in Children

OBJECTIVE. The purpose of this study is to evaluate the association between sonographic findings and the operative time of transumbilical laparoscopic-assisted appendectomy (TULAA) for appendicitis in children. MATERIALS AND METHODS. We included 131 children who underwent ultrasound within 24 hours before TULAA. We evaluated the associations between operative time and patient's demographics, as well as the following sonographic findings: maximum outer wall diameter of the appendix, appendicolith, ascites (not echogenic), echogenic ascites, abscess formation, increased intraabdominal fat echo in the right lower quadrant (RLQ; 3-point scale), and the location of the appendix (three locations). The results were analyzed using simple linear regression or the t test and a multiple liner regression model. RESULTS. The mean (+/- SD) patient age was 9.50 +/- 2.92 years (range, 3-15 years), and the mean operative time was 73.04 +/- 36.56 minutes (range, 25-210 minutes). Univariate analysis showed that higher body mass index, greater maximum outer wall diameter of the appendix, higher grade of intraabdominal fat echo in the RLQ, presence of appendicolith, presence of echogenic ascites, abscess formation, and location of the appendix in the pelvis were associated with increased operative time. Multivariate analysis found that abscess formation and higher grade of increased intraabdominal fat echo in the RLQ were independently associated with operative time (both p < 0.05). CONCLUSION. Preoperative sonographic findings of abscess formation and increased intraabdominal fat echo in the RLQ were factors independently associated with prolonged operative time for TULAA. On the basis of these sonographic findings, surgeons may predict additional surgical procedures, including abscess aspiration or adhesiolysis, and operative time before beginning the operation.