C. N. Litz1, S. M. Farach1, P. D. Danielson1, N. M. Chandler1 1All Children’s Hospital Johns Hopkins Medicine,Pediatric Surgery,Saint Petersburg, FL, USA
Introduction:
Single-incision laparoscopic appendectomy (SILA) has emerged as a less invasive alternative to conventional laparoscopy and has been reported to be safe in appendicitis. However, little is known about the clinical implications of obesity on outcomes following SILA. The purpose of this study was to assess the impact of body habitus on outcomes following SILA.
Methods:
A retrospective review of 413 patients who underwent SILA from July 2012 through April 2015 was performed. Body mass index (BMI) was calculated and the BMI percentile was obtained according to CDC guidelines for gender and age. Standard definitions for overweight (BMI 85-94%) and obese (BMI>95%) were used. General admission, demographic, and outcome data were collected and analyzed. Statistical significance was set at p<0.05.
Results:
SILA was performed in 413 patients during the study period, of which 66.3% were normal weight, 16% were overweight, and 17.7% were obese. There were no significant differences in age at presentation (11.58 ± 3.75 vs 11.87 ± 3.23 vs 10.83 ± 3.53 years, p=0.196), WBC (14.74 ± 5.15 vs 15.41 ± 5.0 vs 15.74 ± 5.51, p=0.3) or time to diagnosis (128 ± 176 vs 120 ± 94 vs 118 ± 92 min, p=0.868) among the groups. Severity of appendicitis was determined intraoperatively as follows: acute (55.5% vs 51.5% vs 50.7%), suppurative (13.5% vs 12.1% vs 23.3%), gangrenous (11.3% vs 18.2% vs 8.2%), perforated (10.2% vs 15.2% vs 12.3%), normal (1.1% vs 0.0% vs 2.7%) and interval appendectomy (8.4% vs 3.0% vs 2.7%). There were no significant differences in intraoperative findings among normal, obese, and overweight patients (p=0.122). Furthermore, there were no significant differences in operative time (26.99 ± 9.11 vs 27 ± 9.80 vs 28.37 ± 9.41 minutes, p=0.514), postoperative length of stay (0.97 ± 1.65 vs 1.53 ± 4.15 vs 1.14 ± 2.27 days, p=0.214), 30 day complications (6.9% vs 8.2% vs 12.1%, p=0.377), ED visits (8.4% vs 11% vs 10.6%, p=0.726) or readmissions (4.7% vs 4.1% vs 4.5%, p=0.972).
Conclusion:
Our results indicate that obesity does not significantly impact outcomes following single-incision laparoscopic appendectomy. SILA can be performed in overweight and obese children without increased rates of perforation, longer operative times, longer length of stay or an increased complication rate. SILA should continue to be offered to overweight and obese children.