N. L. Gates1, R. D. Rampp1, S. D. Bhattacharya1 1University Of Tennessee College Of Medicine,Department Of Surgery,Chattanooga, TN, USA
Introduction: Single-incision laparoscopic appendectomy (SILA) in the pediatric population has been well described in small case series and met analyses. Our children’s hospital has adopted this modality for nearly all appendectomies since 2012. In a review of 1000 consecutive cases from 2012-2017, we hoped to identify factors that portend conversion from SILA to multiport appendectomy. We compared our cohort of conventional three port laparoscopic appendectomy (CLA) for outcomes including operative time, post-op length of stay, complications and readmission.
Methods: A retrospective chart review of 1000 patients who underwent appendectomy from March 2012 to February 2017 at a single Children’s Hospital was performed. The type of appendectomy performed (single incision, conventional multiport, open), if the case was converted from single incision to multiport or open, and perforation status were recorded. Demographic data identified included age, sex, and BMI. Outcomes analyzed were operative time, length of stay, and postoperative complication/readmission rate.
Results: Of 1001 appendectomies during the study period, 959 (95.9%) were initiated with plan for SILA, 35 (3.5%) were initiated CLA, and 6 (0.6%) were initiated via open approach. Of those initiated SILA, 884/959 (92.2%) were able to be completed without additional port placement. Cases initiated SILA for perforated appendicitis had a higher rate of conversion to multiport (22/169, 13%) than cases initiated SILA for non-perforated appendicitis (45/782, 5%; p<0.01). Cases which were not able to be completed SILA were statistically significantly more likely to be older, male patients, or have increased BMI. When compared to cases which were initiated CLA for perforated appendicitis, SILA- regardless of conversion- remained statistically similar for operative times and length of stay but had higher return to emergency department. We found no statistically significant risk factors among any of the subgroups identified for increased morbidity such as small bowel obstruction, UTI, readmission, or abscess/reinterventions.
Conclusion: Single incision laparoscopic appendectomy appears to be a safe and easily adopted modality for the treatment of appendicitis in pediatric populations with no increased morbidity. Parents of children that are obese, males or present with perforation should be counselled regarding the possibility of additional port placement or considered for initiating conventional laparoscopic appendectomy.