DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20150893

Two-port vs. conventional (three-port) laparoscopic appendicectomy: a new technique in laparoscopic appendicectomy

Hemant P. Mhatre, Vijay B. Kanake, Vipul V. Nandu

Abstract


Background: Three-port laparoscopic appendicectomy has proven its worth in the management of appendicitis. From a cosmesis, the umbilical and suprapubic portsites are hidden by natural camouflages, the Right Iliac Fossa (RIF) port is the only visible external sign of surgery. The two-port technique avoids even this marker of abdominal invasion.  

Methods: 58 patients were studied for this study. Data was collected prospectively. The two port appendicectomy was performed with 10 mm umbilical working port and 5 mm supra-pubic camera port. A stitch was taken transparietaly in RIF which was under camera guidance passed through the tip of appendix and held with suture to retract the appendix. The base was ligated with an intra-corporeal knot and appendix cut and delivered out. Three port appendicectomy was performed via the 10 mm umbilical, 5 mm supra-pubic and 5mm right iliac fossa ports. The appendicular stump was ligated with an endoloop or an intra-corporeal knot, appendix cut and delivered out

Results: 58 patients underwent surgery over the one year period for appendicitis. Out of 26 cases attempted, the two port appendicectomy was successful in 21 cases, with conversion to the three-port technique in 4 and conversion to open in 1 case. The complication rates, return to work were comparable between the two groups. Duration of operation was more whereas length of hospital stay was less in two port appendicectomy group as compared to conventional laparoscopic group.

Conclusions: Patients who underwent two port appendicectomy had a cosmetically better appearing scar than compared to three port appendicectomy cases.


Keywords


Laparoscopic appendicectomy, Two-port appendicectomy, Two port vs. three port, Scar

Full Text:

PDF

References


Semm K. Endoscopic appendectomy. Endoscopy. 1983;15(2):59-64.

Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, et al. Laparoscopic versus conventional appendectomy--a meta-analysis of randomized controlled trials. BMC Gastroenterol. 2010;10:129.

Eypasch ESS, Lefering R, Neugenbauer EM. Laparoscopic versus open appendectomy: between evidence and common sense. Dig Surg. 2002;(19):518-22.

Yagnik VD, Rathod JB, Phatak AG. A retrospective study of two-port appendectomy and its comparison with open appendectomy and three-port appendectomy. Saudi J Gastroenterol. 2010;16(4):268-71.

Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc. 1999;9(1):17-26.

Chamberlain RS, Sakpal SV. A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy. J Gastrointest Surg. 2009;13(9):1733-40.

Romanelli JR, Earle DB. Single-port laparoscopic surgery: an overview. Surg Endosc. 2009;23(7):1419-27.

Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2004;(4):CD001546.

Sato N, Kojika M, Yaegashi Y, Suzuki Y, Kitamura M, Endo S, et al. Mini-laparoscopic appendectomy using a needle loop retractor offers optimal cosmetic results. Surg Endosc. 2004;18(11):1578-81.

Fazili FM, Al-Bouq Y, El-Hassan OM, Gaffar HF. Laparoscope-assisted appendectomy in adults: the two-trocar technique. Ann Saudi Med. 2006;26(2):100-4.

Valioulis I, Hameury F, Dahmani L, Levard G. Laparoscope-assisted appendectomy in children: the two-trocar technique. Eur J Pediatr Surg. 2001;11(6):391-4.

Gotz F, Pier A, Bacher C. Modified laparoscopic appendectomy in surgery. A report on 388 operations. Surg Endosc. 1990;4(1):6-9.

Meyer A, Preuss M, Roesler S, Lainka M, Omlor G. Transumbilical laparoscopic-assisted “one-trocar” appendectomy -- TULAA -- as an alternative operation method in the treatment of appendicitis. Zentralbl Chir. 2004;129(5):391-5.

Kollmar O, Z'graggen K, Schilling MK, Buchholz BM, Büchler MW. The suprapubic approach for laparoscopic appendectomy. Surg Endosc. 2002;16(3):504-8.

Matthews BD, Mostafa G, Harold KL, Kercher KW, Reardon PR, Heniford BT. Minilaparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech. 2001;11(6):351-5.

Schier F. Laparoscopic appendectomy with 1.7-mm instruments. Pediatr Surg Int. 1998;14(1-2):142-3.

Ates O, Hakgüder G, Olguner M, Akgür FM. Single-port laparoscopic appendectomy conducted intracorporeally with the aid of a transabdominal sling suture. J Pediatr Surg. 2007;42(6):1071-4.

Roberts KE. True single-port appendectomy: first experience with the “puppeteer technique”. Surg Endosc. 2009;23(8):1825-30.

Udwadia TE. Single-incision laparoscopic surgery: an overview. J Minim Access Surg. 2011;7(1):1-2.

Rao PP, Rao PP, Bhagwat S. Single-incision laparoscopic surgery - current status and controversies. J Minim Access Surg. 2011;7(1):6-16.

Konstadoulakis MM, Gomatos IP, Antonakis PT, Manouras A, Albanopoulos K, Nikiteas N, et al. Two-trocar laparoscopic-assisted appendectomy versus conventional laparoscopic appendectomy in patients with acute appendicitis. J Laparoendosc Adv Surg Tech A. 2006;16(1):27-32.