Two-port Laparoscopic Appendectomy: Maximally Versatile Minimally Invasive Surgery

R S Brooks, MD RVT. St. Mary’s Hospital and Community Hospital Grand Junction, CO

 

BACKGROUND

Conventional laparoscopic appendectomy (LA) is performed via 3-port laparoscopic methods.  Novel 2 and single port LA have gained increasing interest.

OBJECTIVE

A retrospective study of 2-port LA is presented to assess safety, outcomes, complications and potential advantages.

MATERIALS/METHODS

During the study interval of 2005-2011, 86 consecutive patients with clinical and imaging findings of appendicitis were identified.  The intent to treat was 2-port LA in all cases.  Pregnant patients were excluded, 2 cases were recommended for open surgery secondary to very young age and prior multiple surgical procedures.  2 elderly patients with delay in presentation, abcess and extensive phlegmon were definitively treated with CT-guided pig-tail catheter drainage and antibiotics.  No other exclusions were made, the study population included complicated appendicitis with gangrene, abcess, phlegmon and comorbidity such as BMI 50.   The  2-port method included a 12mm periumbilical port, 15mm suprapubic port, 10mm operating laparoscope, 2.5 X 12 and 3.5 X 12mm articulating endo GIA staplers.

RESULTS

2-port LA was successful in 80 patients, (93%.)   2 patients required conversion to open secondary to extensive phlegmon formation.  No major morbidity was encountered, including no infectious complications, surgical site infection, abcess or fistula.  One patient sustained a periumbilical port site hernia requiring surgical revision.

CONCLUSIONS

2-port LA is a safe, efficient, versatile method with a high success rate, including complicated appendicitis.  2 working ports allow port selection for optimal stapler orientation, the 15mm suprapubic port allows retrieval of enlarged appendix and mesoappendix tissue without risk of fragmentation or contamination.   2-port LA may be associated with less post-procedural pain and is cosmetically appealing.


Session Number: Poster – Poster Presentations
Program Number: P091
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