Clinical Outcomes of Single-incision Laparoscopic Appendectomy Versus Conventional Laparoscopic Appendectomy in Adult Acute Appendicitis

Abstract

Objectives Laparoscopic surgery is widely performed for acute appendicitis. We started conventional 3-port laparoscopic appendectomy (CLA) in 1995 and introduced single-incision laparoscopic appendectomy (SILA) in 2009. This study compared perioperative outcomes between SILA and CLA to evaluate the usefulness of SILA.

Design Retrospective observational study.

Methods The study included 568 patients who underwent emergency or semi-emergency surgery for acute appendicitis (327 by CLA and 241 by SILA) at our hospital between January 2009 and December 2020. Perioperative outcomes were compared between SILA and CLA after adjusting for patient demographics by propensity score matching (PSM).

Results PSM gave a matched sample of 224 patients in each of the CLA and SILA groups. There were significant differences between the two groups in time to initiation of oral intake, frequency of postoperative analgesic use, and length of postoperative hospital stay. Time to oral intake was significantly shorter in the SILA group (p = 0.02). Frequency of use of all analgesics, flurbiprofen axetil, and loxoprofen sodium was significantly higher in the SILA group (p < 0.01, p = 0.04, p < 0.01, respectively). The length of postoperative hospital stay was significantly shorter in the SILA group (p < 0.01). The incidence of postoperative complications did not differ significantly between the two groups.

Conclusions Although SILA required significantly more postoperative analgesics than CLA, pain could be controlled by oral analgesics, and patients could be discharged earlier. Postoperative complications were comparable between the two groups. SILA was a safe and feasible procedure for adult acute appendicitis.