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Single-port laparoscopic surgery in uncomplicated acute appendicitis: a randomized controlled trial

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Abstract

Background

Single-port laparoscopic surgery (SPLS) is an alternative, minimally invasive surgical approach for managing appendicitis. The aim of this randomized trial was to evaluate the safety and efficacy of SPLS in uncomplicated appendicitis.

Methods

Between December 2009 and November 2010, 194 patients with radiologically diagnosed acute appendicitis were randomly allocated to undergo either SPLS or multiport laparoscopic surgery (MPLS). Patients with intraoperative findings of perforated appendicitis were excluded from the analysis. The primary endpoint was perioperative morbidity. All data were analyzed according to the intention-to-treat principle.

Results

Fourteen cases were excluded from the analysis. Of the remaining 180 patients, 90 were assigned to the SPLS group, and 90 to the MPLS group. Baseline characteristics were well balanced between the groups. In the SPLS group, the rate of conversion to MPLS was 11.1%. The operation time was 14.5 min longer for SPLS than for MPLS (p < 0.01), but there was no between-group difference in the rate of intraoperative complications (SPLS, 4.4%; MPLS, 0%; p = 0.12) or postoperative complications (SPLS, 4.4%; MPLS, 2.2%; p = 0.68). Compared to the MPLS group, the SPLS group had higher cumulative dose of analgesics (tramadol; 73.9 vs. 51.7 mg, p = 0.04), longer postoperative time to first passage of flatus (27.7 vs. 20.1 h, p < 0.01), longer postoperative hospitalization (2.5 vs. 2.1 days, p < 0.05), and higher total cost (1826.9 vs. 1662.4 USD, p < 0.01).

Conclusions

This randomized trial indicates that, compared to MPLS, SPLS does not increase the rate of perioperative or postoperative complications in uncomplicated appendicitis, but may have disadvantages such as increased operation time, later postoperative functional recovery, longer hospital stay, and higher costs, although the difference is minimal (ClinicalTrials.gov Identifier: NCT01007318).

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Authors and Affiliations

  1. Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea

    Byung Mo Kang

  2. Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, South Korea

    Sung Il Choi, Bum-Soo Kim & Suk-Hwan Lee

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  1. Byung Mo Kang
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  2. Sung Il Choi
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Correspondence to Suk-Hwan Lee.

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Byung Mo Kang, Sung Il Choi, Bum Soo Kim, and Suk-Hwan Lee have no conflicts of interest or financial ties to disclose.

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Kang, B.M., Choi, S.I., Kim, BS. et al. Single-port laparoscopic surgery in uncomplicated acute appendicitis: a randomized controlled trial. Surg Endosc 32, 3131–3137 (2018). https://doi.org/10.1007/s00464-018-6028-0

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  • DOI: https://doi.org/10.1007/s00464-018-6028-0

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