Shintaro Kohama, MD, Masaki Fukunaga, MD, PhD, Tetsu Fukunaga, MD, PhD, Kunihiko Nagakari, MD, PhD, Masaru Suda, MD, PhD, Yoshito Iida, MD, PhD, Kunihiro Yamasawa, MD, PhD, Seiichiro Yoshikawa, MD, PhD, Masakazu Ouchi, MD, PhD, Goutaro Katsuno, MD, PhD, Satoshi Kanda, MD, PhD, Mayuko Ito, MD, PhD, Yoshinori Hirasaki, MD, PhD, Yukinori Yube, MD, PhD, Daisuke Azuma, MD, PhD, Jun Nomoto, MD, PhD. Juntendo Urayasu Hospital, Juntendo University
Background: We adopt a single-incision or double-incision laparoscopic appendectomy (SILA or DILA) in selected patients to improve cosmesis and also reduce the incisional morbidity. We evaluated SILA and DILA by comparing these 2 techniques to conventional laparoscopic appendectomy (CLA) for complicated appendicitis including perforated or gangrenous appendicitis with or without localized or disseminated peritonitis.
Indications: In this study, SILA was basically applied to complicated cases, e.g. gangrenous appendicitis and appendicitis with local peritonitis. However, “Plus one-port technique (DILA)” was performed when it was technically difficult to complete SILA because of some reasons: abdominal severe adhesions, small abscess formation, disseminated inflammations, individual surgeon experience, etc.
Methods: Between January 2009 and May 2015, we retrospectively analyzed 298 patients who had undergone laparoscopic appendectomy for complicated appendicitis. Of them, 68 had undergone SILA, 35 had undergone DILA and 195 had undergone CLA. We compared these three groups for background factors, intraoperative findings, postoperative findings, and hospital stay.
Results: In these three groups, 68 patients with gangrenous appendicitis were found in SILA, 32 in DILA and 182 in CLA. 3 patients with perforated appendicitis were found in DILA and 13 in CLA. As for type of intra-abdominal contamination, 67 patients with local peritonitis were found in SILA, 29 in DILA and 165 in CLA. The number of diffuse peritonitis was 1 in SILA, 2 in DILA and 9 in CLA. 21 patients with abscess formation were found in CLA and 4 in DILA. There were no abscess formation cases in the SILA group. We tended to perform RPS (SILA and DILA) for appendicitis with local peritonitis (p<0.05). Preoperative WBC counts were similar among three groups though CRP levels were higher in the CLA than in the SILA and DILA (p<0.05). Operating time, intraoperative blood loss and hospital stay were shorter and smaller in the SILA and DILA than in the CLA (p<0.05). Oral intake was shorter in the SILA than in the CLA (p<0.05). There were no significant differences among three groups in postoperative complications, including wound infection, intra-abdominal abscess, and postoperative ileus. However, analgesic requirements were higher in the SILA than in the CLA.
Conclusion: This study indicates that RPS (SILA and DILA) are safe and feasible in selected patients for complicated appendicitis.