Pain after single-incision versus conventional laparoscopic appendectomy: a propensity-matched analysis

BACKGROUND: The aim of this study was to compare postoperative pain outcomes between single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA) using a propensity score matching analysis.

MATERIALS AND METHODS: Adult patients who underwent SILA or CLA for acute appendicitis between January 2010 and December 2015 at a single center were identified retrospectively from a prospectively collected database. All patients had used an intravenous patient-controlled analgesia (PCA) device for postoperative pain control. As potential confounding variables, patient characteristics and surgery-related, anesthesia-related, and PCA-related factors were collected from the database. The primary outcome was the postoperative pain score, and secondary outcomes were nausea, vomiting, rescue analgesic use, rescue antiemetic use, and PCA-related complications. These outcomes were compared between the SILA and CLA groups before and after 1:1 propensity score matching.

RESULTS: From a total of 915 patients, 753 were selected: 116 in the SILA group and 637 in the CLA group. After propensity score matching, two comparable groups with 111 patients each were obtained. Pain score (P = 0.007) and rescue analgesic use (P = 0.043) on the day of surgery were significantly lower in the SILA group than in the CLA group. The other outcomes were similar between the two groups.

CONCLUSIONS: SILA is a beneficial surgical procedure for postoperative pain management.