General Surgery and Emergency Unit, Department of General and Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Villarroel 170, 9th stair, 4th floor, 08036 Barcelona, Spain.
Surg Endosc. 2011 Apr;25(4):1019-23. doi: 10.1007/s00464-010-1307-4. Epub 2010 Aug 25.
At the present time, and given the increasing concern about body image, laparoscopic surgeons are faced with an increasing number of patients who want to conserve the umbilicus free of scars for cosmetic reasons. Single-incision laparoscopic surgery (SILS) using the suprapubic approach for appendectomy, while keeping the advantages of SILS through an umbilical incision, leaves the visible abdomen without scars. Moreover, insertion of an additional port in patients with retrocecal or purulent or gangrenous acute appendicitis requiring intra-abdominal drainage is avoided. This report describes the initial experience with suprapubic SILS appendectomy.
Between September 2009 and December 2010, patients with acute appendicitis admitted to the General Surgery and Emergency Unit of the authors' institution and who agreed to undergo SILS appendectomy through the suprapubic approach were included in a prospective study. Demographics, clinical characteristics, and surgical outcome were recorded.
A total of 20 patients (12 men and 8 women) with a mean age of 30 ± 3 years underwent suprapubic SILS appendectomy. The mean duration of the operation was 40 ± 7 min. Placement of a suction drain was necessary in four patients. The mean length of hospital stay was 2 ± 0.5 days. The operation was completed successfully in all patients, and conversion to either multiport or open surgery was not required. No intraoperative or postoperative complications occurred. In all patients, the appearance of the suprapubic wound was good at 7 days after surgery.
Suprapubic SILS appendectomy offers better, cosmetically appealing results than the standard umbilical access. In case of retrocecal or purulent or gangrenous acute appendicitis, the view provided via the suprapubic approach makes access to and dissection of the appendix easy, and it also enables exteriorization of a drain without adding new lateral incisions.
目前，由于人们对身体形象的关注度不断增加，腹腔镜外科医生面临着越来越多的患者希望出于美容原因保留脐部无疤痕。经脐部单切口腹腔镜手术（SILS）用于阑尾切除术，同时保留 SILS 通过脐部切口的优势，使可见的腹部没有疤痕。此外，避免在需要腹腔内引流的盲肠后或化脓性或坏疽性急性阑尾炎患者中插入额外的端口。本报告介绍了耻骨上 SILS 阑尾切除术的初步经验。
2009 年 9 月至 2010 年 12 月，作者所在机构普外科和急诊部收治的同意行经耻骨上入路 SILS 阑尾切除术的急性阑尾炎患者纳入前瞻性研究。记录人口统计学、临床特征和手术结果。
共有 20 名（12 名男性和 8 名女性）平均年龄 30 ± 3 岁的患者接受了耻骨上 SILS 阑尾切除术。手术平均持续时间为 40 ± 7 分钟。4 名患者需要放置引流管。平均住院时间为 2 ± 0.5 天。所有患者均成功完成手术，无需转换为多孔或开放手术。术中或术后无并发症发生。所有患者术后 7 天耻骨上伤口外观良好。
耻骨上 SILS 阑尾切除术比标准脐部入路提供更好的美容效果。对于盲肠后、化脓性或坏疽性急性阑尾炎，耻骨上入路提供的视野使得阑尾的进入和解剖变得容易，并且还可以在不增加新的侧切口的情况下引出引流管。
