A Prospective Randomized Controlled Trial of Single-Port and Three-Port Laparoscopic Appendectomy in Children

Gołębiewski, Andrzej; Anzelewicz, Stefan; Wiejek, Agnieszka; Lubacka, Dominika; Czauderna, Piotr

doi:10.1089/lap.2018.0560

Cited by 16 publications

(7 citation statements)

References 28 publications

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“…In children, two recent RCTs showed that SILA is feasible with an acceptable margin of safety, although it does not produce any significant difference in terms of analgesic use and length of hospital stay [145], and it is associated with longer operative times and more severe surgical trauma compared with the three-port technique, as measured by CRP and IL-6 levels [146]. In the large meta-analysis by Zhang et al, no significant differences were observed between SILA and CLA with respect to the incidence of total postoperative complications, IAA, ileus, wound hematoma, length of hospital stay, or the frequency of use of additional analgesics.…”

Section: Q44: Does Laparoscopic Single-incision Surgery Confer Any mentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Section: Q44: Does Laparoscopic Single-incision Surgery Confer Any mentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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“…Thirteen studies (seven in adults, 23,45–50 four with a mixed population 39,51–53 and two in children) 54,55 investigated the efficacy of single-incision laparoscopic appendicectomy compared with conventional three-port laparoscopic appendicectomy.…”

Section: Resultsmentioning

confidence: 99%

“…Out of the two trials in the paediatric population, one reported significantly increased pain intensity ratings and opioid consumption associated with single-incision laparoscopic appendicectomy 55 . In both studies, baseline analgesia was administered.…”

Section: Resultsmentioning

confidence: 99%

“…34 This review from 2010 was updated by Jaschinski et al in 2018 but found no additional evidence. 35 Single-versus three-port incisional laparoscopic appendicectomy Thirteen studies (seven in adults, 23,[45][46][47][48][49][50] four with a mixed population 39,[51][52][53] and two in children) 54,55 investigated the efficacy of single-incision laparoscopic appendicectomy compared with conventional three-port laparoscopic appendicectomy.…”

Section: Paediatric Patientsmentioning

confidence: 99%

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Perioperative pain management for appendicectomy

Freys,

Bigalke,

Mertes

et al. 2024

European Journal of Anaesthesiology

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BACKGROUND Despite being a commonly performed surgical procedure, pain management for appendicectomy is often neglected because of insufficient evidence on the most effective treatment options. OBJECTIVE To provide evidence-based recommendations by assessing the available literature for optimal pain management after appendicectomy. DESIGN AND DATA SOURCES This systematic review-based guideline was conducted according to the PROSPECT methodology. Relevant randomised controlled trials, systematic reviews and meta-analyses in the English language from January 1999 to October 2022 were retrieved from MEDLINE, Embase and Cochrane Databases using PRISMA search protocols. ELIGIBILITY CRITERIA We included studies on adults and children. If articles reported combined data from different surgeries, they had to include specific information about appendicectomies. Studies needed to measure pain intensity using a visual analogue scale (VAS) or a numerical rating scale (NRS). Studies that did not report the precise appendicectomy technique were excluded. RESULTS Out of 1388 studies, 94 met the inclusion criteria. Based on evidence and consensus, the PROSPECT members agreed that basic analgesics [paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)] should be administered perioperatively for open and laparoscopic appendicectomies. A laparoscopic approach is preferred because of lower pain scores. Additional recommendations for laparoscopic appendicectomies include a three-port laparoscopic approach and the instillation of intraperitoneal local anaesthetic. For open appendicectomy, a preoperative unilateral transverse abdominis plane (TAP) block is recommended. If not possible, preincisional infiltration with local anaesthetics is an alternative. Opioids should only be used as rescue analgesia. Limited evidence exists for TAP block in laparoscopic appendicectomy, analgesic adjuvants for TAP block, continuous wound infiltration after open appendicectomy and preoperative ketamine and dexamethasone. Recommendations apply to children and adults. CONCLUSION This review identified an optimal analgesic regimen for open and laparoscopic appendicectomy. Further randomised controlled trials should evaluate the use of regional analgesia and wound infiltrations with adequate baseline analgesia, especially during the recommended conventional three-port approach. REGISTRATION The protocol for this study was registered with the PROSPERO database (Registration No. CRD42023387994).

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“…In addition, SPLA has been studied in many countries with different types of patients, from adults to children, with desirable results (9). Besides, SPLA has been studied in many countries with different patients, from adults to children, with desirable results (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Single-Port Laparoscopic Appendectomy Performing by Emergency Operation: An Intervention Study in Vietnam

Pham

Tuyet

et al. 2021

Trends in Med Sci

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Background: Appendectomy is one of the most commonly performed surgical procedures of the abdominal area. One of the recent innovations is single-port laparoscopic surgery (SPLS), which can insert multiple ports through a proprietary device with multiple channels. An incision is sited in the umbilicus to result in no visible scar. Objectives: The study aimed to evaluate the results of the treatment of acute appendicitis by applying single-port laparoscopic surgery. Methods: A clinical single-port laparoscopic appendectomy intervention of 122 patients, with the absence of a control group, was carried out by a sole surgeon at the Hue University of Medicine and Pharmacy Hospital, Hue, Vietnam, from August 2013 to December 2017. Research parameters included clinical history, physical examination, laboratory test, ultrasound imaging, intraoperative characteristics, and surgical outcomes. Results: We included 122 patients (64 males and 58 females) who met the inclusion criteria. The mean age was 31.28 ± 13.51 years (range, 16 - 73 years). The average BMI was 20.4 ± 1.39 kg/m2. All patients had abdominal pain, and the average duration of symptoms was 17.39 ± 5.41 hours (range, 6 - 31 hours). Five patients had a history of abdominal surgery. The mean diameter of appendicitis in ultrasound was 8.8 mm (range, 6 - 15 mm). Moreover, 89.3% of patients had an increase in white blood cells. The difficult location of appendicitis was 1.6% under the liver and 20.5% in the retrocecal region. In addition, 18.0% of retroperitoneal appendicitis and 6.6% of appendicitis were under cecalserosa. The mean operative time was 40.19 ± 14.67 mins (range, 23 - 150 min). Two cases (1.6%) required additional trocar insertion. Three cases (2.5%) had wound infection and no other complications. The median hospital stay was 3.64 ± 1.72 days (range, 2 - 13 days). Conclusions: Single-port laparoscopic surgery is the safe and effective treatment of acute appendicitis. This technique may be feasible for acute appendicitis with a difficult location.

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A Prospective Randomized Controlled Trial of Single-Port and Three-Port Laparoscopic Appendectomy in Children

Cited by 16 publications

References 28 publications

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Perioperative pain management for appendicectomy

Single-Port Laparoscopic Appendectomy Performing by Emergency Operation: An Intervention Study in Vietnam

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