Laparoscopic appendectomy is the treatment of choice for acute appendicitis. Further reduction of the invasiveness of the laparoscopic approach may increase postoperative advantages including reduction of pain, preservation of the abdominal wall, and cosmetic amelioration. We proposed to selected patients with acute appendicitis a purely laparoscopic technique of appendectomy using a single umbilical incision.
Single incision appendectomy was attempted in 55 patients (36 women and 19 men). Inclusion criteria were the presence of a non complicated acute appendicitis (i.e., without abscess or peritonitis), the absence of major abdominal surgical antecedent, and BMI < 35 kg/m². Patients informed consent was required. Under general anesthesia, an umbilical incision of 15 mm was performed. Two 5 mm trocarts were inserted in the same umbilical incision. The meso-appendix was coagulated using bipolar cautery or energy scissors. Ligation was performed using material. The appendix was retrieved through the 5 mm port.
The procedure was a success in 41 patients (74.5 %). In 14 patients, conversion to conventional laparoscopic appendectomy occurred. The mean operative time was 36 minutes (14-111). The post-operative rate of complications was 1.8 % with one patient who had an umbilical superficial surgical site infection. The mean length of hospital stay was 34 hours (8-69).
Single incision appendectomy is a sure and feasible technique in selected patients with acute appendicitis. Further improvement of the minimally invasive virtues of laparoscopy may allow appendectomy to be performed on a day surgery basis in France.
Session: Podium Presentation
Program Number: S029