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2026, Number 3-4

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Rev Mex Cir Endoscop 2026; 27 (3-4)

Single-port appendectomy versus three-port appendectomy: What can we expect at five years of follow-up?

Estrada-Gómez RA, Ruvalcaba-Vallarta JM, Ramírez-Cisneros FJ, Hernández-Cárdenas CA, Fukumoto-Inukai KA

Language: Spanish
References: 30
Page: 83-90
PDF size: 1505.06 Kb.


ABSTRACT

Introduction: acute appendicitis remains the leading cause of emergency surgery worldwide. While three-port laparoscopic appendectomy (TPLA) continues to be the gold-standard approach, single-incision laparoscopic appendectomy (SILA) has emerged as an alternative technique, reportedly offering improved cosmetic outcomes and greater patient satisfaction, albeit with longer operative times and an increased risk of incisional hernia. Objective: this study aims to compare perioperative and postoperative outcomes of SILA (Single Incision Laparoscopic Appendectomy) and TPLA (Three-Port Laparoscopic Appendectomy) in adult patients during short, and medium term postoperative followup. Material and methods: we conducted a prospective cohort study of patients undergoing SILA versus TPLA performed by two surgical teams from February 2015 to August 2018. We compared perioperative complications, length of hospital stay, cosmetic outcomes, and follow-up for 5 years. Statistical analysis was done using SPSS 29. Results: a total of 171 patients were included, with 91 in the SILA group and 80 in the TPLA group. There were no significant differences in age and body mass index between groups. A statistically significant difference in sex distribution was observed. There was a higher number of patients with complicated acute appendicitis in the SILA group. The surgical time in the SILA group was significantly shorter than in the TPLA group (35 minutes versus 46 minutes, p < 0.001). Post-surgical complications in both groups showed no statistical difference (p = 0.874). Conclusions: in this cohort, SILA was associated with shorter operative time, improved cosmetic outcomes, and shorter hospital stays, without increasing significantly the rates of complications, readmissions, or the need for additional interventions.


REFERENCES

  1. Krzyzak M, Mulrooney SM. Acute appendicitis review:background, epidemiology, diagnosis, and treatment.Cureus. 2020; 12: e8562.

  2. Semm K. Endoscopic appendectomy. Endoscopy. 1983; 15:59-64.

  3. Di Saverio S, Podda M, De Simone B, Ceresoli M,Augustin G, Gori A et al. Diagnosis and treatment ofacute appendicitis: 2020 update of the WSES Jerusalemguidelines. World J Emerg Surg. 2020; 15: 27.

  4. Junker H. Laparoscopic tubal ligation by the single puncturetechnique. Geburtshilfe Frauenheilkd. 1974; 34: 952-955.

  5. Pelosi MA, Pelosi MA 3rd. Laparoscopic hysterectomy withbilateral salpingo-oophorectomy using a single umbilicalpuncture. N J Med. 1991; 88: 721-726.

  6. Pelosi MA, Pelosi MA 3rd. Laparoscopic appendectomyusing a single umbilical puncture (minilaparoscopy). JReprod Med. 1992; 37: 588-594.

  7. Wu S, Shen Y, Wang J, Wei J, Chen X. Conventional threeportlaparoscopic appendectomy versus transumbilical andsuprapubic single-incision laparoscopic appendectomyusing only conventional laparoscopic instruments.Langenbecks Arch Surg. 2022; 407: 3623-3629.

  8. Forster S, Bernhardt J, Ludwig K. Appendectomy: openversus laparoscopic versus single port : Evidence for choiceof surgical procedure. Chirurg. 2019; 90: 186-193.

  9. Liang HH, Hung CS, Wang W, Tam KW, Chang CC, LiuHH et al. Single-incision versus conventional laparoscopic appendectomy in 688 patients: a retrospective comparativeanalysis. Can J Surg. 2014; 57: E89-E97.

  10. Lee WS, Choi ST, Lee JN, Kim KK, Park YH, Lee WK et al.Single-port laparoscopic appendectomy versus conventionallaparoscopic appendectomy: a prospective randomizedcontrolled study. Ann Surg. 2013; 257: 214-218.

  11. Cirocchi R, Cianci MC, Amato L, Properzi L, BuononatoM, Di Rienzo VM et al. Laparoscopic appendectomy withsingle port vs conventional access: systematic review andmeta-analysis of randomized clinical trials. Surg Endosc.2024; 38: 1667-1684.

  12. Aly OE, Black DH, Rehman H, Ahmed I. Single incisionlaparoscopic appendicectomy versus conventional threeportlaparoscopic appendicectomy: A systematic reviewand meta-analysis. Int J Surg. 2016; 35: 120-128.

  13. Zhao L, Liao Z, Feng S, Wu P, Chen G. Single-incision versusconventional laparoscopic appendectomy in children: asystematic review and meta-analysis. Pediatr Surg Int. 2015;31: 347-353.

  14. von Elm E, Altman DG, Egger M, Pocock SJ, GøtzschePC, Vandenbroucke JP. The Strengthening the Reportingof Observational Studies in Epidemiology (STROBE)statement: guidelines for reporting observational studies. JClin Epidemiol. 2008; 61: 344-349.

  15. Draaijers LJ, Tempelman FR, Botman YA, Tuinebreijer WE,Middelkoop E, Kreis RW et al. The patient and observerscar assessment scale: a reliable and feasible tool for scarevaluation. Plast Reconstr Surg. 2004; 113: 1960-1965;discussion 1966-1967.

  16. Urbach DR, Harnish JL, McIlroy JH, Streiner DL. A measureof quality of life after abdominal surgery. Qual Life Res.2006; 15: 1053-1061.

  17. Shafi S, Aboutanos M, Brown CV, Ciesla D, Cohen MJ,Crandall ML et al. American Association for the Surgeryof Trauma Committee on Patient Assessment andOutcomes. Measuring anatomic severity of disease inemergency general surgery. J Trauma Acute Care Surg.2014; 76: 884-887.

  18. Grijalva Estrada OB, Garrido Pérez JI, Murcia Pascual FJ,Ibarra Rodríguez MR, Paredes Esteban RM. Clavien-Dindoclassification: a tool to assess complications followingsurgical treatment in children with acute appendicitis. CirPediatr. 2022; 35: 18-24.

  19. Thayaparan AJ, Mahdi E. The Patient SatisfactionQuestionnaire Short Form (PSQ-18) as an adaptable,reliable, and validated tool for use in various settings. MedEduc Online. 2013; 18: 21747.

  20. Kang KC, Lee SY, Kang DB, Kim SH, Oh JT, Choi DH etal. Application of single incision laparoscopic surgery forappendectomies in patients with complicated appendicitis.J Korean Soc Coloproctol. 2010; 26: 388-394.

  21. Liao YT, Lai PS, Hou YZ, Wu CY, Chou TH, Liang JT. Issingle-incision laparoscopic appendectomy suitable forcomplicated appendicitis? A comparative analysis withstandard multiport laparoscopic appendectomy. Asian JSurg. 2020; 43: 282-289.

  22. Liu J, Chen G, Mao X, Jiang Z, Jiang N, Xia N et al. Singleincisionlaparoscopic appendectomy versus traditionalthree-hole laparoscopic appendectomy for acuteappendicitis in children by senior pediatric surgeons: amulticenter study from China. Front Pediatr. 2023; 11:1224113.

  23. Kim JH, Kim HY, Park SK, Lee JS, Heo DS, Park SW etal. Single-incision laparoscopic appendectomy versusconventional laparoscopic appendectomy: experiencesfrom 1208 cases of single-incision laparoscopicappendectomy. experiences from 1208 cases of singleincisionlaparoscopic appendectomy. Ann Surg. 2015; 262:1054-1058.

  24. Zaman S, Mohamedahmed AYY, Srinivasan A et al. Singleportlaparoscopic appendicectomy versus conventionalthree-port approach for acute appendicitis: A systematicreview, meta-analysis and trial sequential analysis ofrandomised controlled trials. Surgeon. 2012; 19: 365-379.

  25. Escobedo BL, Hernández LAH, Muñoz JD, Méndez JM,Valdés A, Gómez-Palacio M et al. Retrospective analysis of120 laparoscopic appendectomies: Utility of clinical scalesand predicting factors for non therapeutic appendix. CirGen. 2018; 40: 243-249.

  26. Chan J, Fan KS, Mak TLA, Loh SY, Ng SWY, Adapala R. Preoperativeimaging can reduce negative appendectomy ratein acute appendicitis. Ulster Med J. 2020; 89: 25-28.

  27. Rud B, Vejborg TS, Rappeport ED, Reitsma JB, Wille-Jorgensen P. Computed tomography for diagnosis of acuteappendicitis in adults. Cochrane Database Syst Rev. 2019;2019: CD009977.

  28. Li C, Liu Y, Jiang Y, Xu Y, Wang Z. Single-incision comparedwith conventional laparoscopy for appendectomy in acuteappendicitis: a systematic review and meta-analysis. Int JColorectal Dis. 2022; 37: 1925-1935.

  29. Vellei S, Borri A. Single-incision versus three-portlaparoscopic appendectomy: short- and long-term outcomes.J Laparoendosc Adv Surg Tech A. 2017; 27: 804-811.

  30. Han Y, Yuan H, Li S, Wang WF. Single-incision versusconventional three-port laparoscopic appendectomyfor acute appendicitis: A meta-analysis of randomizedcontrolled trials. Asian J Surg. 2024; 47: 864-873.




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