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Surgical Endoscopy

, Volume 30, Issue 11, pp 4917–4923 | Cite as

One-trocar versus multiport hybrid laparoscopic appendectomy: What’s the best option for children with acute appendicitis? Results of an international multicentric study

  • Ciro EspositoEmail author
  • Maria Escolino
  • Holger Till
  • Mirko Bertozzi
  • Giovanna Riccipetitoni
  • Alessandro Settimi
  • Francois Varlet
Article

Abstract

Background

One-trocar laparoscopic appendectomy (OTA) is routinely adopted in children with acute appendicitis. In case of a difficult appendectomy, it is necessary to add additional trocar/s to safely complete the procedure. This technique is called multiport hybrid laparoscopic appendectomy (HLA). We aimed to compare the outcome of multiport HLA versus OTA.

Methods

We retrospectively reviewed the data of 1,092 patients underwent LA in 5 European centers of pediatric surgery in the last 5 years. We compared 2 groups: G1 of 575 patients (52.6 %) (average age 10 years) underwent OTA and G2 of 517 patients (47.4 %) (average age 8.2 years) underwent multiport HLA.

Results

No intra-operative complications occurred in both groups. An additional pathology was treated in 12 cases (8 Meckel’s diverticulum, 2 carcinoids, 2 ovarian cysts) in G2. Operative time was significantly shorter in G2 compared to G1 (47.8 vs 58.6 min; p < .001). The average analgesic requirement was significantly shorter in G2 compared to G1 (44 vs 56 h; p < .001). As for postoperative complications, the incidence of port-site infections was similar between the two groups, while the incidence of postoperative abdominal abscesses (PAA) was significantly higher in G1 compared to G2 (4.7 vs 0.2 %; p < .001). The cosmetic outcome was excellent in all patients of both groups. A subgroup analysis between complicated and uncomplicated appendicitis showed that only in complicated cases, the average operative time, the average VAS pain score, the average analgesic requirements and the incidence of PAA were significantly higher in OTA group compared to multiport HLA group (p < .001).

Conclusions

Our results suggest that OTA is a valid and safe procedure for the uncomplicated cases, while additional trocars are required in case of complicated appendicitis. Multiport HLA significantly reduces the operative time, the incidence of abdominal abscesses and the analgesic requirements compared to OTA.

Keywords

Appendectomy Trocars Hybrid Ports Children 

Notes

Compliance with ethical standards

Disclosures

Drs Ciro Esposito, Maria Escolino, Holger Till, Mirko Bertozzi, Giovanna Riccipetitoni, Alessandro Settimi, and Francois Varlet declare that they have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ciro Esposito
    • 1
    Email author
  • Maria Escolino
    • 1
  • Holger Till
    • 2
  • Mirko Bertozzi
    • 3
  • Giovanna Riccipetitoni
    • 4
  • Alessandro Settimi
    • 1
  • Francois Varlet
    • 5
  1. 1.Department of Translational Medical SciencesFederico II University of NaplesNaplesItaly
  2. 2.Department of Pediatric SurgeryMedical University of GrazGrazAustria
  3. 3.Department of Pediatric SurgeryUniversity of PerugiaPerugiaItaly
  4. 4.Department of Pediatric SurgeryBuzzi HospitalMilanItaly
  5. 5.Department of Pediatric SurgeryCentre Hospitalier Universitaire, Hopital NordSaint-ÉtienneFrance

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