Carrillo Montenegro Andrés Felipe, Aristizabal Rojas Sofía, Pulido Segura Jean André, Pedraza Mauricio, Padilla Laura, Lozada-Martinez Ivan David, Rafael Narvaez-Rojas Alexis, Cabrera-Vargas Luis Felipe
Department of General Surgery, Universidad El Bosque, Bogotá, Colombia.
Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia.
Heliyon. 2023 Jan 19;9(1):e12972. doi: 10.1016/j.heliyon.2023.e12972. eCollection 2023 Jan.
The single-port (SPL) and multi-port (MPL) laparoscopic approach are the gold standard of management of acute appendicitis, due to its multiple advantages over open surgery, mainly because of its direct effects on recovery, esthetics and costs of the procedure. However, in third-world countries, the laparoscopic approach is not yet fully reproducible due to the costs of the technique. The surgical-glove port single incision laparoscopic appendectomy (SGP-SILA) has been proposed as a viable option. However, it has never been studied in Colombia.
To evaluate the cost-effectiveness and reliability of SGP-SILA in the management of complicated acute appendicitis, compared to traditional MPL approach.
A retrospective case control study was carried out comparing patients undergoing laparoscopic appendectomy by SGP-SILA vs. MPL, evaluating operating costs associated with intraoperative and postoperative variables in two tertiary centers in Bogota, Colombia. The data were analyzed and expressed according to their nature and distribution.
116 patients were included (SGP-SILA: 62 and MPL: 54). The median surgical time for SGP-SILA was 60 min vs. 39 min for MPL. SGP-SILA was shown to cause lower frequency of surgical site infection (4 vs. 8 patients; p = 0.047). It was found a significant correlation between Grade III surgical site infection and surgery time (p = 0.047) in the MPL group; also, with hospital stay (p < 0.001). Also, a lower risk of surgical site infection was found with the SGP-SILA technique (22% vs. 31%). SGP-SILA generated a reduction in both direct and indirect operating costs of approximately 10% (616 USD vs. 683 USD).
SGP-SILA and MPL are feasible and comparable procedures in the resolution of complicated acute appendicitis. SGP-SILA turns out to be more cost-effective compared to MPL, due to the use of more easily accessible instruments. This may be a reproducible technique in low- and middle-income countries.
单孔（SPL）和多孔（MPL）腹腔镜手术方法是急性阑尾炎治疗的金标准，因其相对于开放手术具有多种优势，主要体现在对恢复、美观和手术费用的直接影响上。然而，在第三世界国家，由于该技术的成本，腹腔镜手术方法尚未完全普及。手术手套端口单切口腹腔镜阑尾切除术（SGP-SILA）已被提出作为一种可行的选择。然而，在哥伦比亚从未对其进行过研究。
与传统的MPL方法相比，评估SGP-SILA在复杂急性阑尾炎治疗中的成本效益和可靠性。
进行了一项回顾性病例对照研究，比较接受SGP-SILA与MPL腹腔镜阑尾切除术的患者，评估哥伦比亚波哥大两个三级中心与术中及术后变量相关的手术成本。根据数据的性质和分布进行分析和表达。
纳入116例患者（SGP-SILA组62例，MPL组54例）。SGP-SILA的中位手术时间为60分钟，而MPL为39分钟。SGP-SILA的手术部位感染发生率较低（4例对8例；p = 0.047）。在MPL组中，发现III级手术部位感染与手术时间之间存在显著相关性（p = 0.047）；此外，与住院时间也存在相关性（p < 0.001）。同时，SGP-SILA技术的手术部位感染风险较低（22%对31%）。SGP-SILA使直接和间接手术成本降低了约10%（616美元对683美元）。
SGP-SILA和MPL在解决复杂急性阑尾炎方面都是可行且具有可比性的手术方法。由于使用了更容易获得的器械，SGP-SILA与MPL相比更具成本效益。这可能是一种在低收入和中等收入国家可推广的技术。
