Is single-incision laparoscopic appendectomy suitable for complicated appendicitis? A comparative analysis with...

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Minimally Invasive Procedures

Background:

• Complicated appendicitis management traditionally uses multiport laparoscopic appendectomy (MPLA).
• Single-incision laparoscopic appendectomy (SILA) shows promise for simple appendicitis, but its use in complicated cases is less established.
• Evaluating SILA's efficacy and safety against MPLA for complicated appendicitis is crucial.

Purpose of the Study:

• To compare the surgical outcomes of SILA versus MPLA in patients with complicated appendicitis.
• To assess the feasibility and safety of SILA for AAST grades II-V appendicitis.
• To evaluate recovery parameters and complications associated with SILA in complicated appendicitis.

Main Methods:

• Retrospective analysis of 40 patients undergoing SILA and 150 patients undergoing MPLA for complicated appendicitis (AAST grades II-V).
• Comparison of demographic data, intraoperative parameters, and postoperative recovery metrics.
• No routine drainage was employed in the SILA group.

Main Results:

• SILA was performed successfully without conversion to MPLA.
• No significant differences in demographics or preoperative severity were noted between groups.
• SILA demonstrated significantly faster resumption of oral intake and shorter hospital stays compared to MPLA (p < 0.001).
• Operation duration was comparable between SILA and MPLA (60.03 ± 21.01 vs. 68.04 ± 32.03 min, p = 0.222).
• Only one case of intra-abdominal hematoma occurred in the SILA group, managed with CT-guided drainage, despite the absence of routine drainage.

Conclusions:

• Single-incision laparoscopic appendectomy (SILA) is a safe and feasible option for managing complicated appendicitis.
• SILA offers comparable or superior outcomes to multiport laparoscopic appendectomy (MPLA) regarding oral intake resumption and hospital stay.
• The findings challenge the necessity of routine postoperative drainage in complicated appendicitis treated with SILA.