Impact of body habitus on single-site laparoscopic appendectomy for nonperforated appendicitis: subset analysis from a prospective, randomized trial.

INTRODUCTION

There have been several series documenting the utility of single-site laparoscopic appendectomy. However, there are no data to support patient selection based on their physical characteristics. We recently completed a large prospective, randomized trial comparing single-site laparoscopic appendectomy with standard three-port laparoscopic appendectomy for nonperforated appendicitis. This dataset was used to examine the relative impact of body habitus on operative approach.

SUBJECTS AND METHODS

We performed an analysis of the dataset collected in a prospective, randomized trial of 360 appendectomy patients who presented with nonperforated appendicitis. Body mass index (BMI) was calculated and plotted on a growth chart to obtain BMI percentile according to gender and age. Standard definitions for overweight (BMI 85-95%) and obesity (BMI >95%) were used.

RESULTS

In the single-site group there were 26 overweight and 19 obese patients. In the three-port group there were 25 overweight and 16 obese patients. There were no significant differences between overweight and normal with either approach. However, with the single-site approach there was longer mean operative time, more doses of postoperative narcotics given, longer length of stay, and greater hospital charges in obese patients. In the three-port group, there were no differences between normal and obese patients.

CONCLUSIONS

When using the single-site approach for appendectomy, obesity in children creates longer operative times, more doses of postoperative analgesics, longer length of stay, and greater charges. However, obesity has no impact on three-port appendectomy.