One, two or three port appendectomy - a rational approach.

Abstract

IntroductionLaparoscopic appendectomy is a safe and feasible technique accepted by many surgeons as the gold standard approach for the treatment of acute appendicitis in children. Traditionally laparoscopic appendectomy requires the use of three ports. However, surgical techniques with fewer ports have been reported.AimTo evaluate the efficacy of laparoscopic appendectomy in children according to the proposed 3-step protocol using one, two or three ports.Material and methodsA total of 100 children with the diagnosis of acute appendicitis underwent laparoscopic appendectomy. Patients were treated according to the following protocol: transumbilical access with one 10 mm port using the laparoscope with working channel. The appendix was mobilized and delivered through the umbilical port and tied extracorporeally and removed. If the appendix was placed retrocecally or had adhesions, a second port was introduced. The appendix was mobilized and finally retrieved from the abdominal cavity through the camera port, and resected extracorporeally. In the cases of very short and gangrenous appendix and immobile colon, a third port was introduced and totally intra-abdominal appendectomy was performed. Patients were evaluated regarding the duration of the operation, and operative and postoperative complications.ResultsDuring the study period 100 children (58 males, 42 females) had laparoscopic appendectomy: 48 children by one-port technique (group I), 27 children by two-port technique (group II) and 25 children by three-port technique (group III). The mean operative time was 33 min (20-55 min) in group I, 39 min in group II (23-60 min), and 49 min (30-75 min) in group III. There were no intraoperative complications. Wound infections were recorded in 4 (8.3%) patients in group I, three (11.1%) in group II and four (16.0%) in group III. One patient in group III developed an abdominal abscess managed conservatively.ConclusionsOne-port laparoscopic appendectomy is a feasible technique in children. It allows 48% of children to have the operation. The addition of a second port allows one to mobilize the appendix and perform extracorporeal resection in an additional 27% of cases. These approaches have shorter operative time compared to 3-port technique. Laparoscopic extracorporeal appendectomy, especially one-port, is found to be cost effective and have excellent cosmetic results.

Can Two-Port Hand Assisted Laparoscopic Appendectomy be a Good Alternative to Open and Three Port Appendectomies?

“…Randomized trials are necessary to describe the benefits of the hand-assisted techniques (9)(10)(11). The extracorporeal technique of appendectomy can be performed as safely and efficiently as the open and full laparoscopic techniques (12)(13)(14)(15). We had only one trocar site infection (2.5%) which was comparable to those of other studies which was in a range of 0% to 10% (3).…”

Laparoscopic versus open appendectomy retrospective study

“…This finding is common in almost all the studies done up to date. [11][12][13] The patients were discharged home after 24 hours in laparoscopic appendectomy while in open group the patient discharged on the second day.…”

Port Exteriorization Appendectomy in children: An Alternative to Conventional Laparoscopic Technique?

“…Only three previous studies concerned pediatric population [6,13,17] Our study has a double interesting point; interest represented by the concerned population (pediatric), and the fact that procedure concerned both uncomplicated and complicated appendicitis. The mean operative time in the published studies ranged from 19 min to 64 min, In the pediatric studies the operative time ranged from 19 [6] to 39minutes [13]. The complications rate ranged in pediatric studies from 5.2 % to 11.1 % [7], In our study like EL-Gohary and al [17] none of the patients developed local wound infection or intra-abdominal abscesses (Table 4).…”

“…Few studies about the port exteriorization appendectomy are available [6,9,[12][13][14][15][16]. Only three previous studies concerned pediatric population [6,13,17] Our study has a double interesting point; interest represented by the concerned population (pediatric), and the fact that procedure concerned both uncomplicated and complicated appendicitis. The mean operative time in the published studies ranged from 19 min to 64 min, In the pediatric studies the operative time ranged from 19 [6] to 39minutes [13].…”