Rodriguez Joe, Vogel Michael, Fan Diana, Elfadaly Ahmed, Saliba Christian, Kurashima Maho, Greenspon Jose, Blewett Christopher, Herman Richard, Miyata Shin
Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, Saint Louis, Missouri, USA.
J Laparoendosc Adv Surg Tech A. 2022 Dec;32(12):1255-1259. doi: 10.1089/lap.2022.0238. Epub 2022 Nov 16.
Single-incision laparoscopic appendectomy (SILA) for the treatment of appendicitis has been documented. Typically, SILA requires the use of specialized ports, instruments, and materials. The SILA technique at our institution utilizes the same instrumentation as the conventional laparoscopic approach (CLA), thus obviating the need for these specialized products. This study aims to further demonstrate the noninferiority of our SILA technique for the treatment of uncomplicated appendicitis. This is a single-institution retrospective review of patients who underwent SILA from 2011 to 2020 to treat uncomplicated appendicitis. Outcomes including demographics, operative time, length of stay (LOS), and common postsurgical complications were evaluated. These SILA cases were matched with up to 3 CLA controls based on age, gender, and weight utilizing the Greedy match method. Patients with an operative diagnosis of perforated appendicitis were excluded. A total of 137 patients underwent SILA at a single institution. A total of 128 patients were in the final cohort after excluding perforated appendicitis. Mean age was 11.9 years. Case-control matching was conducted with 349 controls included. Between cases and controls, SILA had shorter operative time (27.2 minutes versus 43.7 minutes, < .001) with no difference in mean LOS (42.4 hours versus 42.4 hours, = .88). There was no difference in complication rate (5.4% versus 8.5%, = .06). There was no difference in readmission rate (0.8% versus 3.4%, = .108). These data suggest that for appropriately selected patients, our SILA technique is noninferior to CLA with shortened operative time.
单切口腹腔镜阑尾切除术(SILA)治疗阑尾炎已有相关记录。通常,SILA需要使用专门的端口、器械和材料。我们机构的SILA技术使用与传统腹腔镜手术方法(CLA)相同的器械,因此无需这些专门的产品。本研究旨在进一步证明我们的SILA技术治疗单纯性阑尾炎的非劣效性。这是一项单机构回顾性研究,对2011年至2020年接受SILA治疗单纯性阑尾炎的患者进行分析。评估了包括人口统计学、手术时间、住院时间(LOS)和常见术后并发症等结果。这些SILA病例根据年龄、性别和体重,采用贪婪匹配法与多达3例CLA对照进行匹配。手术诊断为穿孔性阑尾炎的患者被排除。在一家机构中,共有137例患者接受了SILA。排除穿孔性阑尾炎后,最终队列中有128例患者。平均年龄为11.9岁。纳入了349例对照进行病例对照匹配。病例组和对照组之间,SILA的手术时间更短(27.2分钟对43.7分钟,<0.001),平均住院时间无差异(42.4小时对42.4小时,=0.88)。并发症发生率无差异(5.4%对8.5%,=0.06)。再入院率无差异(0.8%对3.4%,=0.108)。这些数据表明,对于适当选择的患者,我们的SILA技术不劣于CLA,且手术时间缩短。