[Laparoscopic "single-port" appendectomy in children].

BACKGROUND: In contrast to the laparoscopic three trocar-technique and to the single incision laparoscopic surgery (SILS), the "single-port" appendectomy (SPA) requires only one port with one integrated instrument channel. We report on our experience with this half-open surgical technique. PATIENTS / MATERIALS AND METHODS: Between September 2006 and August 2008 a total of 285 children underwent an appendectomy, 265 in SPA technique. Through a 10 mm subumbilical inserted ballon trocar, diagnostic laparoscopy was routinely performed and, afterwards, the appendix was grasped with a 450 mm forceps, exteriorised and dissected outside the abdomen as in open surgery. Patients with perforated appendicitis detected by preoperative ultrasonography were operated by open appendectomy.

RESULTS: 94 % of the SPA were performed successfully with no conversion. In six patients (2.3 %), a second trocar was inserted, in seven children (2.6 %), an extension of the incision became necessary. There were three conversions (1.1 %) to open surgery. The median operating time was 50 min and the median length of hospital stay 4 days. Three children had postoperative wound infections (1.1 %).

CONCLUSIONS: SPA is a safe alternative to conventional appendectomy techniques, in part also in cases of perforated appendicitis. The minimal scarring guarantees an attractive cosmetic result. The diagnostic laparoscopy enables one to obtain additional information. In the case of extended adhesions, an extension of the incision and / or the use of a second trocar may be helpful.