Acute appendicitis. Comparative study of single port, conventional laparoscopic versus laparotomy

Abstract

Objective: To compare the three techniques approach appendectomy: single port (SPA), conventional laparoscopy (CLA) and laparotomy (LA) in patients with acute appendicitis. Methods: LA was performed by McBurney incision, CLA was performed with three ports and SPA. LigaSure clamp 10mm Hand AtlasTM 37cms (Covidien®) was used to cut the mesoappendix, chromic suture catgut® 0 or endoloop® to ensure the base of the appendix, in open or laparoscopic, respectively. The SILS™ Port (Covidien®) was used for the SPA. A comparative, prospective, single-center study was conducted between April 2014 and October 2014, in patients with a diagnosis of acute appendicitis in East General Hospital "Dr. Domingo Luciani" and who met the inclusion criteria. Results: 58 appendectomies, 20 LA, 20 CLA and 18 SPA were  performed. The operative time and hospital stay were lower in the CLA average of 47 minutes and 33.6 hours, respectively. The incidence of intraoperative and postoperative complications were higher on the LA establishing a statistically significant relationship between surgical  technique and surgical site infection (p <0.05). The surgical technique influences the manifestation of pain in the first 08 hours postoperatively (p <0.05). Conclusion: The decision of surgical approach will be determined by the surgeon's experience and availability of surgical instruments, however, current evidence suggests that CLA should be considered as first choice.