Different variations of the laparoscopic technique have been proposed, all aiming to better cosmetic results, reduction in costs, and charges for hospitals, while keeping the safety of the operation unchanged. The umbilicus as the unique site to more info gain access to the abdomen and to the appendix has been widely reported in the literature, both as a port to exteriorize the appendix and perform an extracorporeal operation [2, 3] and as the site to place all laparoscopic instruments and perform an intracorporeal appendectomy (SILS; single-site laparoscopic surgery) [4, 5]. The trans umbilical laparo-assisted technique (TULAA) merges together the advantages of both a good intraabdominal laparoscopic visualization and the safety and quickness of an extracorporeal traditional appendectomy.

A large series of pediatric patients operated on with this technique was presented in 1999 by Valla et al. [2], but patients were selected for absence of complicated appendicitis. Recently, Ohno et al. presented a paper in which the TULAA procedure was used in 416 patients but without any perforated appendicitis or local abscesses in the series [6]. We present the experience of our centre, in which the use of TULAA was firstly introduced in 2006, in a team where only one surgeon had used the technique before, and it was decided to perform it with every kind of appendicitis, with or without the suspect of complicated appendicitis. 2.

Materials and Methods The charts of all patients admitted to our surgical department from January 2006 to December 2010, with a diagnosis of appendicitis based on clinical (migration of pain to right lower quadrant (RLQ), fever, and rebound tenderness in RLQ), laboratory (elevated WBC count, elevate C Reactive Protein (CRP)), and ultrasound (US) findings were retrospectively reviewed for demographical data, surgical treatment, time for completing the operation, intraoperative finding, need for conversion, and surgical complications. Before 2006, all suspected appendicitis, regardless of history and perforation status, were treated by open surgery, and antibiotic therapy was prescribed according to the preference of the surgeon. Since 2006, a new protocol for the treatment of complicated and uncomplicated appendicitis was introduced in our surgical department. 2.1.

Protocol of Treatment All patients with suspected nonperforated or perforated appendicitis but with a history of less than 72 hours and no ultrasound evidence of consolidated appendiceal mass are offered TULAA. All patients undergoing surgery are administered a single dose of ampicillinplussulbactam (50mg/kg/dose) as prophylaxis 30�� before starting the operation. If there is no perforation, the therapy with the same antibiotic is continued for 24 hours and then stopped; whenever perforation AV-951 is found, a regimen of ceftriaxone (100mg/kg/die in one administration) plus metronidazole (7.