Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis

Abstract

The objective of this study was to compare the perioperative outcomes between single incision laparoscopic appendectomy (SILA) and three port appendectomy (CLA) in enhanced recovery after surgery (ERAS) protocol. Methods: Of 101 laparoscopic appendectomy with ERAS protocol cases for appendicitis from March 2019 to April 2020, 54 patients underwent SILA with multimodal analgesic approach (group 1) while 47 patients received CLA with multimodal analgesic approach (group 2). SILA and CLA were compared with the single institution's ERAS protocol. To adjust for baseline differences and selection bias, operative outcomes and complications were compared after propensity score matching (PSM). Results: After 1:1 PSM, well-matched 35 patients in each group were evaluated. Postoperative hospital stays for patients in group 1 (1.2±0.8 vs. 1.6±0.8 days, p =0.037) were significantly lesser than those for patients in group 2. However, opioid consumption (2.0 mg vs. 1.4 mg, p =0.1) and the postoperative visual analogue scores for pain at 6 hours (2.4±1.9 vs. 2.8±1.4, p = 0.260) and 12 hours (2.4±2.0 vs. 2.9±1.5, p=0.257) did not show significant difference between the two groups. Conclusion: SILA resulted in shortening the length of hospitalization without increase in complications or readmission rates compared to CLA with ERAS protocol.

Systematic review and meta-analysis of the effects of the perioperative enhanced recovery after surgery concept on the surgical treatment of acute appendicitis in children

“…Early postoperative oral nutrition intake can reduce the damage of postoperative pulmonary function, restore gastrointestinal peristalsis as soon as possible, reduce activity and enhance cardiovascular function. As a new surgical concept, accelerated surgery has greatly changed the perioperative treatment of many surgical operations (8,9). However, accelerated rehabilitation surgery has been gradually applied by surgeons in clinical practice, and its safety and effectiveness in treating acute appendicitis in children have yet to be confirmed.…”

Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis

“…The LOS after a laparoscopic appendectomy varies by country, surgeon' preference, and culture. Recently, the mean LOS after a laparoscopic appendectomy for uncomplicated appendicitis ranged from 1.6 to 4.2 days in Korea [15,18] and from 0 to 3 days in other countries [19,20]. The relatively longer hospital stays in Korea probably reflect a generous national public medical insurance system.…”

“…Therefore, our results are reliable. Some studies reported that operative time was associated with prolonged LOS after laparoscopic appendectomy [12,13,15], although the mechanism is unclear. It is well known that difficult cases require extended duration of treatment, including pneumoperitoneum, irrigation, and other surgical maneuvers, which may contribute to contamination of the abdominal cavity [21].…”

“…The patients were divided into 2 groups according to the postoperative LOS as described in a previous study [15]. The early discharge group was defined by a LOS of within 2 postoperative days, and the late discharge group was defined by a LOS exceeding 3 postoperative days.…”

Acute appendicitis–advances and controversies

“…Laparoscopic appendectomy can be performed by a single port or conventional three-port technique. A study involving 101 patients by Kim et al [ 105 ] reported that Single-incision laparoscopic appendectomy (SILA) reduced the length of hospitalization (1.2 ± 0.8 d vs 1.6 ± 0.8 d, P = 0.037) vs three-port appendectomy[ 105 ]. Systematic reviews and meta-analyses report that SILA is associated with a shorter length of hospital stay but longer operation duration and increased risk of open conversion[ 106 , 107 ].…”