Hosokawa T, et al. - Through 131 children with appendicitis who underwent ultrasound within 24 hours before transumbilical laparoscopic-assisted appendectomy (TULAA), the researchers assessed the association between sonographic findings and the operative time of TULAA. A correlation of increased operative time with higher body mass index, greater maximum outer wall diameter of the appendix, higher grade of intraabdominal fat echo in the right lower quadrant (RLQ), presence of appendicolith, presence of echogenic ascites, abscess formation, and location of the appendix in the pelvis was observed. Further, an independent association of preoperative sonographic findings of abscess formation and higher grade of increased intraabdominal fat echo in the RLQ with operative time for TULAA was found. Hence, beginning the operation, additional surgical procedures, including abscess aspiration or adhesiolysis, and operative time could be predicted by the surgeons, through the above mentioned sonographic findings.