Single-port laparoscopic access as the method of choice for surgical intervention in patients with acute appendicitis
DOI:
https://doi.org/10.11603/2414-4533.2023.2.13797Keywords:
appendicitis, laparoscopy, laparoscopic appendectomy, single-port laparoscopic appendectomyAbstract
The aim of the work: evaluation of the effectiveness of single-port laparoscopic access in patients with acute appendicitis.
Materials and Methods. A comparative analysis of the indicators of 74 patients operated on for acute appendicitis from 2020 to 2022 was conducted according to the criteria: patient characteristics (age, sex, BMI), duration of surgery and hospital stay, abdominal drainage, anesthesiological assessment of ASA, pain level and use opioid analgesics in the postoperative period, presence of intra- and postoperative complications, cosmetic result. Including patients with appendicitis without local complications and the duration of the disease up to 48 hours; excluded patients with perforation of the appendix, periappendicular abscess, widespread peritonitis. 33 (44.6 %) patients (group 1) underwent single-port laparoscopic appendectomy (SILA), 41 (55.4 %) patients (group 2) had multi-port laparoscopic appendectomy (MLA).
Results and Discussion. The most significant differences in treatment results were found in the first group of patients (SILA) regarding the level of pain and satisfaction with the cosmetic result. It is necessary to conduct a thorough assessment of the patient, when choosing a method of surgical intervention. The patient’s age, gender, BMI, and the presence of local complications (appendicular infiltrate, abscess, gum disease) play an important role. The duration of the disease over 48 hours and complications of acute appendicitis determine the need for multiport laparoscopic appendectomy. One-port access should be used, if the patient has an umbilical hernia. This method makes possible to achieve tightness in the hernia gate to maintain sufficient pneumoperitoneum. Performance of conversions of single-port laparoscopic access is most often due to technical difficulties due to the impossibility of achieving adequate exposure of the appendix and difficulties in its mobilization. In such cases, it is possible to install an additional trocar or switch to multiport laparoscopic access, sometimes laparotomy.
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