Single-incision laparoscopic appendectomy versus conventional laparoscopic appendectomy:Experiences from 1208 cases of single-incision laparoscopic appendectomy

Objective: Currently single-incision laparoscopic appendectomy (SIL-A) has become an option for treating appendicitis. The aim of this study was to evaluate the safety and feasibility of SIL-A compared with conventional laparoscopic appendectomy (CL-A) on a large experimental cohort. Background: Several studies had reported the safety and technical feasibility of SIL-A, albeit with a limited number of study subjects. Methods: A total of 2587 patients (1208 SIL-A and 1379 CL-A) who underwent laparoscopic appendectomy from May 2008 to April 2013 were studied retrospectively. The clinical characteristics and short-term operative outcomes of these patients were reviewed and analyzed. Results: There were more simple type appendicitis in the SIL-A group and more complicated type appendicitis in CL-A group (81.0% vs 74.7% and 19% vs 25.3%, P <0.001, respectively). The operative time (minutes) was similar between the 2 groups (40.1±18.6 vs 38.8±25.2, P=0.154). However, on subgroup analysis, operative time for simple type appendicitis was longer in the SIL-A group (36.6±14.9 vs 32.3±18.3, P <0.001). The superficial incisional surgical site infection rate was higher in the SIL-A group (4.4% vs 2.3%, P=0.003). The readmission rate was higher in the CL-A group (0.8% vs 1.7%, P=0.042). The postoperative hospital stay (days) was shorter in the SIL-A group (3.05±1.97 vs 3.35±2.14, P <0.001). Conclusions: In this study, SIL-Awas technically feasible and safe option for appendicitis. The SIL-A group had more favorable outcomes such as shorter time to start diet and less hospital stay after surgery than the CL-A group. However, superficial incisional surgical site infection rate was higher in the SIL-A group than in the CL-A group, an effort to reduce superficial incisional SSI should be made.