Application of single incision laparoscopic surgery for appendectomy in children

Abstract

PurposeRecently, single incision laparoscopic surgery (SILS) has been popular in use with its progress studied for more minimally invasive surgery and cosmetic improvement. We investigated the feasibility and efficacy of SILS for appendectomy (SILS-A) in children and compare it with conventional laparoscopic appendectomy (C-LA).MethodsWe studied, retrospectively, adolescent patients who underwent C-LA or SILS-A. There were 25 patients in the C-LA group and 30 patients in the SILS-A group. The clinical outcomes were compared between the groups.ResultsThe SILS-A procedures were performed successfully in adolescent patients . There were no significant difference between the C-LA and SILS-A group with respect to demographic data and post-operative outcomes. There was one complication (4%) in the C-LA group and two complications (6.6%) in the SILS-A group, but there was no significant difference.ConclusionSILS-A was technically feasible and safe in children. Considering little postoperative scar and no difference in post-operative outcomes compared to C-LA, SILA could be applicable in adolescent patients. Larger studies and further technical implements will be necessary to assess the true benefit of this approach.

Systematic review and meta-analysis of single-incision versus conventional laparoscopic appendectomy in children

“…Severe cases, identified by the presence of perforation, gangrene or abscess, were not included in four studies [25,34,37,41]. In some studies [27,28,31,37,38,40,41], the surgeon divided the peritoneal attachments to the appendix and cecum during laparoscopy and mobilized the appendix to the umbilicus in SILA. Then, the inflammatory appendix was exteriorized and an extracorporeal appendectomy was performed.…”

“…The study design was retrospective in 9 [25,27,31,34,35,37,[39][40][41], prospective nonrandomized in 3 [28,32,36], and randomized in 2 studies [33,38]. The included studies were conducted in the USA, Europe and Asia, and were published between 2008 and 2014.…”

“…Four studies [28,31,33,39] reported the occurrence of postoperative wound hematoma. A meta-analysis showed a higher incidence of postoperative wound hematoma of 5.3% (5 of 94) in the SILA group compared with 1.1% (1 of 89) in the CLA group, although this difference was not statistically significant (OR = 2.52; 95% = 0.56-11.21; P = 0.23).…”

“…All fourteen studies [25,27,28,[31][32][33][34][35][36][37][38][39][40][41] reported the total number of postoperative complications after appendectomy. The incidence of postoperative complications was 6.5% (48 of 743 cases) for the SILA group compared with 7.5% (112 of 1495 cases) for the CLA group.…”

“…Finally, two [24,25], two [26,27], and three [28][29][30] studies were performed by the same author, respectively; therefore, we chose the most informative and recent article or merged information from multiple publications (different publications that used the same study sample). Eventually, fourteen studies [25,27,28,[31][32][33][34][35][36][37][38][39][40][41] matched the selection criteria and were suitable for the meta-analysis. These included 9 retrospective studies [25,27,31,34,35,37,[39][40][41], 3 prospective nonrandomized studies [28,32,36] and 2 prospective randomized studies [33,38], with a combined total of 2249 subjects.…”