Outcomes of Single-Incision Laparoscopic Appendectomy at a Single Center

Takahiro Watanabe, Hidetosi Wada, Masanori Sato, Yuichirou Miyaki, Junpei Tochikubo, Norihiko Shiiya

Division of General Surgery and Endoscopic Surgery, Surgery I, Hamamatsu University School of Medicine, Hamamatsu, Japan.

DOI: 10.4236/ss.2013.410083                

Abstract

Background and Objectives: Recently, single-incision laparoscopic surgery has been popular for minimally invasive surgery and cosmetic improvement. We studied outcomes of single-incision laparoscopic appendectomy (SILA) in accordance with our strategy for acute appendicitis. Methods: Clinical outcomes were revealed in each of nine emergency SILA (e-SILA) cases and eight interval SILA (i-SILA) cases performed for the treatment of acute appendicitis between September 2010 and August 2012 at our hospital. Results: The male to female ratio was 6:3 for e-SILA and 5:3 for i-SILA cases. Mean ages were 33.1 ± 17.8 years and 41 ± 21.6 years for e-SILA and i-SILA, respectively. The pretreatment white blood cell (WBC) count and C-reactive protein (CRP) levels were 14960 ± 4080/μL and 1.4 ± 2.3 mg/d, respectively, for e-SILA and 12657 ± 4290/μL and 6.7 ± 8.3 mg/d, respectively, for i-SILA. The maximum transverse diameter of appendix was 12.6 ± 3.5 mm for e-SILA and 11.6 ± 3.5 mm for i-SILA. Appendiceal abscesses were encountered in one (11%) e-SILA and three (38%) i-SILA cases. Perforation of the appendix at operation occurred in two (22%) e-SILA cases and no i-SILA cases. Generalized peritonitis occurred in 4 (44%) e-SILA cases but in none of the i-SILA cases. The postoperative hospital stay was 5.3 days for e-SILA, 2.7 days for i-SILA. Conversion to laparotomy was not required in either group. One additional trocar was needed for an e-SILA case, and paralytic ileus occurred as a postoperative complication in one e-SILA case. Conclusion: The outcomes of SILA performed under our strategy were acceptable and useful without major postoperative complications.

Keywords

Laparoscopic Appendectomy; Single Access Laparoscopic Surgery; Minimally Invasive Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	K. Semm, “Endoscopic Appendectomy,” Endoscopy, Vol. 15, No. 2, 1983, pp. 59-64. http://dx.doi.org/10.1055/s-2007-1021466
[2]	S. Towfigh, F. Chen, R. Mason, N. Katkhouda, L. Chan and T. Berne, “Laparoscopic Appendectomy Significantly Reduces Length of Stay for Perforated Appendicitis,” Surgical Endoscopy and Other Interventional Techniques, Vol. 20, No. 3, 2006, pp. 495-499. http://dx.doi.org/10.1007/s00464-005-0249-8
[3]	M. N. Khan, T. Fayyad, T. D. Cecil and B. J. Moran, “Laparoscopic versus Open Appendectomy: The Risk of Postoperative Infectious Complications,” Journal of the Society of Laparoendscopic Surgeons, Vol. 11, No. 3, 2007, pp. 363-367.
[4]	R. Golub, F. Siddiqui and D. Pohl, “Laparoscopic versus Open Appendectomy: A Metaanalysis,” Journal of the American College of Surgeons, Vol. 186, No. 5, 1998, pp. 545-553. http://dx.doi.org/10.1016/S1072-7515(98)00080-5
[5]	J. A. Margenthaler, W. E. Longo, K. S. Virgo, et al., “Risk Factors for Adverse Outcomes after the Surgical Treatment of Appendicitis in Adults,” Annals of Surgery, Vol. 238, No. 1, 2003, pp. 59-66. http://dx.doi.org/10.1097/01.SLA.0000074961.50020.f8
[6]	A. A. Saber, M. H. Elgamal, T. H. El-Ghazaly, A. V. Dewoolkar and A. Akl, “Simple Technique for Single Incision Transumbilical Laparoscopic Appendectomy,” International Journal of Surgery, Vol. 8, No. 2, 2010, pp. 128-130. http://dx.doi.org/10.1016/j.ijsu.2009.12.001
[7]	J. Lee, J. Baek and W. Kim, “Laparoscopic Transumbilical Single-Port Appendectomy: Initial Experience and Comparison with Three-Port Appendectomy,” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, Vol. 20, No. 2, 2010, pp. 100-103. http://dx.doi.org/10.1097/SLE.0b013e3181d84922
[8]	H. J. Kim, J. I. Lee, Y. S. Lee, et al., ”Single-Port Transumbilical Laparoscopic Appendectomy: 43 Consecutive Cases,” Surgical Endoscopy, Vol. 24, No. 11, 2010, pp. 2765-2769. http://dx.doi.org/10.1007/s00464-010-1043-9
[9]	J. A. Lee, K. Y. Sung, J. H. Lee and D. S. Lee, “Laparoscopic Appendectomy with a Single Incision in a Single Institute,” Journal of the Korean Society of Coloproctology, Vol. 26, No. 4, 2010, pp. 260-264. http://dx.doi.org/10.3393/jksc.2010.26.4.260
[10]	D. B. Kang, S. H. Lee, S. Y. Lee, et al., “Application of Single Incision Laparoscopic Surgery for Appendectomy in Children,” Journal of the Korean Surgical Society, Vol. 82, No. 2, 2012, pp. 110-115. http://dx.doi.org/10.4174/jkss.2012.82.2.110