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2014 ; 76
(3
): 243-6
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Stepwise approach to laparoscopic appendicectomy in children
#MMPMID25177128
Sarkar A
; Tantoco J
; Kimber C
; Heloury Y
; Ferguson P
; Cheng W
Indian J Surg
2014[Jun]; 76
(3
): 243-6
PMID25177128
show ga
Traditionally, three ports are used in laparoscopic appendicectomy. However to
reduce surgical incision and cost, it is feasible to remove the appendix using
fewer ports. In this study, we compared the efficacy of stepwise and standard
approach in laparoscopic appendicectomies in children. Between August 2008 and
September 2010, 378 children with appendicitis were allotted to either the
stepwise or standard laparoscopy group depending on the operating surgeon's
preference. In the former group, an operating telescope was inserted first. The
number of ports used was based on the pathology (stepwise approach). In the
latter group, three ports were inserted in all patients (standard approach). The
two groups were similar. In the stepwise group, we performed 95 single port
(utilising a scope with an instrument channel), 37 two ports and 13 three ports
appendicectomies. In the stepwise group, operating time was shorter (not yet
statistically significant) and it reduced the port numbers by more than 50 %. The
stepwise approach provides an evidence-based management of appendicitis with
comparable outcomes. This procedure further reduces incision trauma, operating
times and the cost of operation. However, the reduction of post-operative
analgesic requirement needs further study.