Department of General Surgery, TC Thompson Children's Hospital, University of Tennessee Health Science Center, Chattanooga, Tennessee.
Department of General Surgery, TC Thompson Children's Hospital, University of Tennessee Health Science Center, Chattanooga, Tennessee.
J Surg Res. 2019 Mar;235:223-226. doi: 10.1016/j.jss.2018.08.050. Epub 2018 Oct 31.
Single-incision laparoscopic appendectomy (SILA) in the pediatric population has been well described. Our children's hospital has adopted this modality for nearly all appendectomies. From our center's experience, we hoped to identify factors that portend conversion from SILA to multiport appendectomy. We compared our cohort of conventional three-port laparoscopic appendectomy (CLA) for outcomes including operative time, postop length of stay (LOS), complications, and readmission.
A retrospective chart review of patients who underwent appendectomy from 2012 to 2017 at our children's hospital was performed. The type of appendectomy performed, if the case required conversion to multiple ports, and perforation status were recorded. Demographic data identified included age, sex, and body mass index. Outcomes analyzed were operative time, LOS, and postoperative complication/readmission rate.
Of 1001 appendectomies performed, 959 (95.9%) were initiated with plan for SILA, and 35 (3.5%) were initiated CLA. Of those initiated SILA, 884/959 (92.2%) were completed without additional port placement. Cases which were not able to be completed SILA were statistically significantly more likely to be male patients, have increased body mass index, or perforated appendicitis. When compared to cases initiated CLA, SILA remained statistically similar for readmission and LOS but had significantly faster operative time.
SILA appears to be a safe and efficient modality for the treatment of appendicitis in pediatric populations with no increased morbidity. Parents of children who are obese, males, or present with perforation should be counseled regarding the possibility of additional port placement or considered for initiating conventional three-port laparoscopic appendectomy.
单切口腹腔镜阑尾切除术（SILA）在儿科中已有很好的描述。我们的儿童医院已经采用这种方式进行几乎所有的阑尾切除术。根据我们中心的经验，我们希望确定预示 SILA 转为多孔阑尾切除术的因素。我们比较了我院常规三孔腹腔镜阑尾切除术（CLA）的队列，以评估手术时间、术后住院时间（LOS）、并发症和再入院率等结果。
对 2012 年至 2017 年在我院行阑尾切除术的患者进行回顾性病历分析。记录手术方式、是否需要转为多孔、穿孔状态等。识别的人口统计学数据包括年龄、性别和体重指数。分析的结果包括手术时间、LOS 和术后并发症/再入院率。
在 1001 例阑尾切除术中，959 例（95.9%）计划行 SILA，35 例（3.5%）计划行 CLA。在计划行 SILA 的患者中，884/959 例（92.2%）无需额外切口即可完成手术。未能完成 SILA 的病例在统计学上更可能为男性、体重指数增加或患有穿孔性阑尾炎。与行 CLA 初始手术的病例相比，SILA 再入院率和 LOS 无统计学差异，但手术时间明显缩短。
SILA 似乎是一种安全有效的治疗小儿阑尾炎的方法，不会增加发病率。对于肥胖、男性或穿孔的儿童，应告知其可能需要额外切口或考虑行常规三孔腹腔镜阑尾切除术。
