The Minimally Invasive Approach to Appendectomy: Is Less Better?

Abstract

The benefits of the three-port laparoscopic appendectomy (TPLA) are now appreciated. Included in these advantages are reduced postoperative pain, reduced hospitalization, early return to routine activities, and a definite cosmetic benefit over the open approach. Recently, the single-incision laparoscopic technique for several disease processes has been popularized. The single-incision approach through the umbilicus is ideally suited for patients with nonperforated appendicitis. This article will review our operative technique for both the TPLA and single-incision laparoscopic appendectomy, and then review the available literature that compares benefits of one approach over the other. When comparing these two approaches, variables that will be discussed include infectious complications, operative time and cost, and the need for postoperative pain medication.

Single site multiport umbilical laparoscopic appendicectomy versus conventional multiport laparoscopic appendicectomy in acute settings

“…3 However, it is mainly suited to non-perforated acute appendicitis cases. 4 Moreover, it needs a skin/fascial incision, which may extend even up to 3.5cm. 5,6 Such a large cut significantly increases the postoperative pain 7 and the rate of incisional hernias, thereby shadowing the advantages of minimally invasive surgery.…”

Current Status of Laparoscopic Appendectomy in Children: A Nation Wide Survey in Germany

“…Whether or not there are benefits of single-incision approaches for LA is still controversial. 13 Other details of the operation are not well standardized. The use of endoscopic clips, endoscopic staplers, or different coagulating devices have been suggested for dissection of the mesoappendix.…”

Systematic Review of Level 1 Evidence for Laparoscopic Pediatric Surgery: Do Our Procedures Comply with the Requirements of Evidence-Based Medicine?

“…However, apart from a possible cosmetic advantage, there does not appear to be any clear advantage of one approach over the other. 31 At this time point, singleincision appendectomy is still poorly studied and only one RCT is available comparing the technique with the three-port laparoscopic approach in children. 32 No differences were detected in wound infection rate, time to full feeds, length of hospital stay, or time to return to full activity.…”