Clinical advantage of umbilical single incision laparoscopic appendectomy; a single center prospective study

Abstract

Background: Single incision laparoscopic surgery (SILS) is widely accepted in clinical practice with its less invasion, cosmetic effectiveness, and quick recovery. Purpose: Our purpose was to assess feasibility and clinical advantage of umbilical single incision laparoscopic appendectomy compared with conventional laparoscopy. Materials: From January 2016 to November 2019, we treated 215 patients admitted with acute appendicitis in Pyongyang University of Medicine Hospital; 82 patients received with umbilical single incision laparoscopic appendectomy (study group) and 133 patients with three port laparoscopic appendectomy (control group). All patients received pain killer (NSAID) every 12 hours postoperatively. Patients were started with a clear liquid diet within 24 hours and advanced to regular diet as tolerated. Clinical outcomes: Primary outcomes were intra-operative bleeding, operation time, conversion rate to open surgery, postoperative pain, pain-loss time, frequency of pain killer, and the incidence of peritoneal drain in 12 hours. Secondary outcomes were hospital stay, cosmetic satisfaction, the incidence of postoperative complications (para-appendicitis, peri appendiceal abscess, hernia), recovery time to normal activities. Results: There were no significant differences in intra-operative bleeding, conversion rate to open surgery and the incidence of peritoneal drain between study and control group. (p>0.05). In study group, postoperative pain, pain-loss time, and frequency of pain killer in 12 hours were significantly decreased compared to control group (p<0.05). However, operation time in study group (34.6±17.5 minutes) had been increased significantly than control group (28.1±15.2 minutes) (p<0.05). The degree of cosmetic effectiveness was higher in study group. The hospital stay and recovery time to normal activities were also significantly decreased in study group (p<0.05). There was no significant difference in postoperative complications between two groups (p>0.05). Conclusion: Umbilical single incision laparoscopic appendectomy is less invasive approach with higher cosmetic effectiveness. It is also associated with a shorter length of stay and a shorter return to normal activities.