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Practical Benefits of Single- vs. Three-Port Laparoscopic Appendectomy for Pain Relief and Long-Term Cosmesis in
Tae Ah Kim1, Won Me Kang2, Soo Min Ahn3
1Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Republic of Korea.
Insights
Single-port laparoscopic appendectomy (SLA) offers statistically significant, though clinically minor, pain relief compared to three-port laparoscopic appendectomy (TLA) in pediatric patients. However, SLA provides superior long-term cosmetic satisfaction and better scar perception, making it a preferable option for children.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Minimally Invasive Surgery
Background:
- Inconsistent results exist regarding postoperative pain and cosmetic outcomes between single-port laparoscopic appendectomy (SLA) and three-port laparoscopic appendectomy (TLA) in pediatric appendicitis.
- Pediatric patients require evaluation for practical benefits of SLA over TLA, focusing on recovery pain and long-term cosmetic satisfaction.
Purpose of the Study:
- To compare postoperative pain reduction and long-term cosmetic satisfaction between SLA and TLA in pediatric patients.
- To assess the impact of surgical approach on scar perception and overall cosmetic outcomes.
Main Methods:
- Prospective comparative study of 238 pediatric patients (≤15 years) with uncomplicated acute appendicitis.
- Pain assessed using Visual Analog Scale for Pain (VASP) on postoperative days 1, 2, and 7.
- Cosmetic satisfaction evaluated using Visual Analog Scale for Cosmesis (VASC) and scar perception using Patient and Parental Scar Assessment Scale (PSAS) at 1 month and 3 years.
- Propensity score matching (PSM) used for sensitivity analysis.
Main Results:
- SLA showed statistically significant pain reduction during ambulation on postoperative day 7, but did not reach minimal clinically important difference (MCID).
- At 3 years, SLA patients reported significantly higher cosmetic satisfaction (VASC score) and better scar perception compared to TLA patients.
- Scar perception mediated 66% of the effect on cosmetic satisfaction, with TLA patients reporting poorer scar characteristics.
Conclusions:
- SLA provides statistically significant but clinically marginal benefits in early postoperative pain relief for pediatric appendicitis.
- SLA offers substantial and clinically meaningful benefits in long-term cosmetic satisfaction and scar appearance compared to TLA in pediatric patients.
Abstract:
Background/Objectives: Comparative studies examining postoperative pain and cosmetic outcomes following single-port laparoscopic appendectomy (SLA) and three-port laparoscopic appendectomy (TLA) in pediatric patients with appendicitis have produced inconsistent results. We aimed to determine whether SLA offers practical benefits over TLA in terms of recovery-phase pain relief and long-term cosmetic satisfaction in pediatric patients. Methods: This prospective comparative study included children aged 15 years or younger who underwent laparoscopic appendectomy for uncomplicated acute appendicitis. The degree of pain reduction was compared between the SLA and TLA groups on postoperative days (PODs) 1, 2, and 7, both at rest and during coughing and ambulation, using the Visual Analog Scale for Pain (VASP). Global cosmetic satisfaction was assessed at 1 month and 3 years postoperatively using the Visual Analog Scale for Cosmesis (VASC). Scar perception was evaluated with the Patient and Parental Scar Assessment Scale (PSAS). The primary outcome was the degree of pain reduction during ambulation on POD7. The secondary outcome was global cosmetic satisfaction at 3 years. Propensity score matching (PSM) was used as a sensitivity analysis to control for baseline differences. Continuous variables were assessed for normality using the Shapiro-Wilk test. Results: Baseline characteristics were similar among 238 patients (127 SLA and 111 TLA). SLA resulted in significantly greater pain reduction during ambulation on POD7 (deltaVASP7_walk: -6.22 ± 2.60 vs. -5.06 ± 3.23, p < 0.01, mean difference = -1.16, Cohen's d = 0.39). However, this difference did not reach the minimal clinically important difference (MCID) threshold of 1.3. PSM analysis with 82 matched pairs confirmed the results, with even larger effect sizes. At 3 years, the SLA group reported significantly higher cosmetic satisfaction (VASC: median 10 [9-10] vs. 8 [6-9], p < 0.001, r = 0.44), surpassing the MCID of 1.5. The TLA group scored worse in scar perception regarding color, stiffness, thickness, and irregularity. Mediation analysis indicated that 66% of the overall effect on cosmetic satisfaction was mediated by scar perception. Conclusions: Although SLA offers statistically significant yet clinically marginal benefits in early postoperative pain reduction, it provides substantial benefits in long-term cosmetic satisfaction compared with TLA in pediatric patients.
