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Single-incision multiport laparoscopy does not cause more pain than conventional laparoscopy: a prospective
Steffi Mayer1, Antje Werner, Robin Wachowiak
1Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany.
Background:
The benefit of single-incision multiport laparoscopy (SIMPL) remains a matter of vivid discussion. For good reason it has been speculated that SIMPL causes more postoperative pain, because a minilaparotomy is required to place the multiport system. We prospectively evaluated postoperative pain scores and requirement of analgesic medication following conventional laparoscopic (CL) versus SIMPL appendectomy in children.
Methods:
The access for laparoscopic appendectomy was decided upon the surgeon's preference. Between April and October 2010, individual abdominal pain scores at 8, 16, 24, 48, and 72 hours postoperatively as well as the incidence of umbilical or shoulder pain and the total amount of peri- and postoperative analgesics, operative time, length of hospital stay, and demographics were assessed. Analgesics (paracetamol and/or metamizole, 15 mg/kg body weight) were administered regularly or on inquiry of the patient. Data are presented as means±standard deviation tested at a significance level of P<.05.
Results:
All operations were laparoscopically completed without conversion or addition of extra ports. Thirty-nine patients (8 SIMPL appendectomy) at a mean age of 12.3±2.4 years and a mean body mass index of 19.16±3.2 kg/m(2) were included. Equal operation times were observed (SIMPL: 68.5±19.9 minutes versus CL: 66.2±19.5 minutes). There were no significant differences for the individual pain scores or the incidence of umbilical and shoulder pain between study groups. The total amount of required analgesic medication was significantly lower after SIMPL appendectomy (SIMPL: 65.73±43.8 mg/kg versus CL: 106.39±46.4 mg/kg, P=.04).
Conclusion:
In summary, the present study substantiates the evidence that SIMPL appendectomy in children and adolescents is not only feasible but also beneficial for the patient without translation into increased postoperative pain. Presently, we are conducting a randomized, blinded study to validate these findings.
Insights
Single-incision multiport laparoscopy (SIMPL) appendectomy in children is safe and effective. This minimally invasive technique resulted in significantly less need for pain medication compared to conventional laparoscopy.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Single-incision multiport laparoscopy (SIMPL) for appendectomy is debated due to concerns about increased postoperative pain.
- Prospective evaluation of pain and analgesic requirements in pediatric appendectomy was needed.
Purpose of the Study:
- To compare postoperative pain scores and analgesic requirements between conventional laparoscopic (CL) and SIMPL appendectomy in children.
- To assess the feasibility and patient benefit of SIMPL appendectomy.
Main Methods:
- Prospective evaluation of 39 children undergoing either CL or SIMPL appendectomy.
- Assessment of pain scores, umbilical/shoulder pain incidence, analgesic use, operative time, and hospital stay.
- Regular or on-demand administration of analgesics (paracetamol/metamizole).
Main Results:
- No significant difference in operative times or pain scores between SIMPL and CL groups.
- Significantly lower total analgesic medication required after SIMPL appendectomy (65.73±43.8 mg/kg) compared to CL (106.39±46.4 mg/kg).
- No conversions or additional ports were necessary in any SIMPL cases.
Conclusions:
- SIMPL appendectomy in children is feasible and beneficial, without increasing postoperative pain.
- Findings suggest SIMPL appendectomy offers advantages over conventional laparoscopy in pediatric patients.
- Further validation through a randomized, blinded study is ongoing.
