Is Single Incision Laparoscopic Appendectomy Feasible in a Developing Country? A Comparative Study

Haris R Shaikh, MBBS FRCS, Mufaddal Mahesri, MBBS, Asad Abbas, MBBS, Hisham R Salahuddin, MBBS. Ziauddin University Hospital, Karachi, Pakistan

Introduction: Single Incision Laparoscopic Surgery (SILS) is an exciting advancement which seeks to completely transform modern Laparoscopic surgery. It was, therefore, natural that this new technique would also be adopted to perform the appendectomy, which is one of the most commonly performed operative procedures. Single Incision Laparoscopic Appendectomy (SILA), offers advantages of reduced post-operative pain and morbidity as well as a shorter hospital stay. Moreover, its excellent cosmetic result makes it very attractive for patients. The purpose of our study was to report our experience of SILA for appendicitis and evaluate if it is safe and feasible in comparison to the conventional multi-port Laparoscopic Appendectomy (LA) which is widely used. It is also important to determine if SILA has any added benefits compared to LA which compensate for the added cost. This is especially relevant in a developing country such as Pakistan where the per capita income is low.

Material and Method: All patients presenting to Ziauddin University Hospital, in Karachi with appendicitis during the period September 2009 to September 2010 were included in the study. Forty two patients underwent SILA while LA was performed on the other 80 patients by the same surgeon. The data was collected prospectively using a pre-designed questionnaire.

Results: In our study both the groups had similar age, BMI and gender distribution. No case of SILA required insertion of additional ports and none of the cases in either group were converted to open surgery. The mean operative time for SILA was 48 minutes (range: 30-125 mins) which was longer than LA (p < 0.001). There was no significant difference in mean operative blood loss, post operative pain, analgesia requirement and mobilization. Patients who underwent SILA were able to return to normal activity earlier than patients undergoing LA (p< 0.001). In most of the cases of SILA the scar was barely visible as opposed to the obviously visible scars of LA.

Conclusion: Our study suggests that SILA is a safe alternative to LA. Compared to LA, SILA has the added benefit of an early return to work along with excellent cosmetic result. The operative time of SILA is seen to be longer than LA but this will improve with experience. However, a major factor in the extensive use of SILA will be the higher cost of the procedure. Therefore, further large scale trials are required to assess the feasibility of SILA especially in a developing country such as Pakistan.