Single site versus conventional laparoscopic appendectomy: some pain for no gain?

Area of Science:

• Pediatric surgery
• Minimally invasive surgical techniques
• Appendectomy outcomes

Background:

• The optimal laparoscopic appendectomy approach remains unclear, with comparisons needed between single-site laparoscopic appendectomy (SILA) and conventional 3-port appendectomy (CLA).
• Evaluating surgical outcomes in pediatric patients is crucial for determining the most effective and safest appendectomy methods.

Purpose of the Study:

• To compare the outcomes of SILA versus CLA in pediatric patients undergoing appendectomy.
• To analyze key metrics including operative time, length of hospital stay, dietary resumption, readmission rates, and associated costs.

Main Methods:

• A retrospective study of pediatric patients (ages 1-18) who underwent appendectomy between 2018 and 2020.
• Data analysis involved two-sample T, chi-squared, and Fisher's exact tests to compare outcomes between SILA and CLA groups.

Main Results:

• No significant differences were observed in operative time (47.0 min SILA vs. 49.5 min CLA), length of stay (2.9 days SILA vs. 2.4 days CLA), or readmission rates (P=0.244).
• The SILA group experienced a statistically significant delay in resuming a regular diet (1.7 days vs. 1.1 days for CLA, P=0.018).
• A trend towards more intra-abdominal abscesses was noted in the SILA group (4 out of 5 readmissions) compared to CLA.

Conclusions:

• Both SILA and CLA demonstrate comparable operative times and overall outcomes in pediatric appendectomy.
• A higher incidence of intra-abdominal abscesses may be associated with SILA, suggesting a need for further research.
• Additional studies with longer follow-up are required to definitively establish the advantages of either laparoscopic approach.