Single-Incision Laparoscopic Appendectomy in Children And Conversion to Multiport Appendectomy

Single-incision laparoscopic appendectomy (SILA) in the pediatric population has been well described. Our children's hospital has adopted this modality for nearly all appendectomies. From our center's experience, we hoped to identify factors that portend conversion from SILA to multiport appendectomy. We compared our cohort of conventional three-port laparoscopic appendectomy (CLA) for outcomes including operative time, postop length of stay (LOS), complications, and readmission.

A retrospective chart review of patients who underwent appendectomy from 2012 to 2017 at our children's hospital was performed. The type of appendectomy performed, if the case required conversion to multiple ports, and perforation status were recorded. Demographic data identified included age, sex, and body mass index. Outcomes analyzed were operative time, LOS, and postoperative complication/readmission rate.

Of 1001 appendectomies performed, 959 (95.9%) were initiated with plan for SILA, and 35 (3.5%) were initiated CLA. Of those initiated SILA, 884/959 (92.2%) were completed without additional port placement. Cases which were not able to be completed SILA were statistically significantly more likely to be male patients, have increased body mass index, or perforated appendicitis. When compared to cases initiated CLA, SILA remained statistically similar for readmission and LOS but had significantly faster operative time.

SILA appears to be a safe and efficient modality for the treatment of appendicitis in pediatric populations with no increased morbidity. Parents of children who are obese, males, or present with perforation should be counseled regarding the possibility of additional port placement or considered for initiating conventional three-port laparoscopic appendectomy.