Practical Advantages of Single-port Over Three-port Laparoscopic Appendectomy in Children
Practical Advantages of Single-port Over Three-port Laparoscopic Appendectomy in Children
Despite growing popularity, practical advantages of single-port laparoscopic appendectomy
 (SLA) over conventional three-port laparoscopic appendectomy (CLA) have yet to be established
 well in pediatric population.

 The investigators designed the randomized controlled trial to clarify practical advantages of
 SLA over CLA in pediatric population. The investigators compared conversion rate,
 intra-operative adverse events, operating time, wound complications, intra-abdominal
 complications, and postoperative hospital stay, changes in postoperative pain severity, and
 cosmetic outcomes during follow up period between SLA and CLA groups.
Currently the single-port laparoscopic appendectomy (SLA) has gained popularity in pediatric
 population since it was first reported in 1998 by Esposito et al. Nonetheless, the practical
 advantages of SLA over conventional three-port laparoscopic appendectomy (CLA) have yet to be
 established well in pediatric population due to lacking and inconsistent high-level evidences
 from randomized trials and meta-analysis.

 Thus far, in addition to overall postoperative hospital stay, complications such as wound
 abscess and seroma, intra-abdominal abscess and ileus were reported not to be significantly
 different between SLA and CLA, while SLA might have taken longer operation time in children
 and adult. Currently, the advertised benefits on postoperative pain and cosmetic results of
 SLA incurred suspicion because of heterogeneous data inconsistently supporting SLA from a few
 RCTs especially in pediatric population. Consequently, a consensus regarding the practical
 superiority of SLA to CLA has still not been reached particularly in children.

 To address this issue, the investigators designed the randomized trial to clarify practical
 benefits of SLA over CLA in pediatric population. For this, the investigators compared
 conversion rate, intra-operative adverse events, operating time, wound complications,
 intra-abdominal complications, and postoperative hospital stay, changes in postoperative pain
 severity, and cosmetic outcomes during follow up period between SLA and CLA groups. Primary
 end points were postoperative pain severity and cosmetic satisfaction. Secondary endpoints
 were intra- and post-operative complication rates, operation time, and postoperative hospital
 stay.
Inclusion Criteria:

 -  Acute appendicitis was diagnosed in accordance with following clinical, laboratory,
 and radiographic criteria; history of right lower quadrant pain or periumbilical pain
 migrating to the right lower quadrant with nausea and/or vomiting. presence direct and
 indirect tenderness on McBurney's point and/or right lower quadrant guarding. a fever
 ≥ 38°C and/or white blood cell counts more than 10X10³ cells per mL on complete blood
 count. diameter of appendix ≥ 6 mm with mural thickening and periappendiceal fat
 infiltration and/or abdominal fluid collection on appendiceal ultrasonography or
 abdominopelvic computed tomography.

 -  Perforated appendicitis: disrupted appendix contour with non-homogenous peritoneal
 fluid collection in pelvic cavity and/or sub-hepatic space simultaneously with above
 mentioned clinical, laboratory, and radiographic findings of appendicitis.

 -  Peri-appendiceal abscess which was preoperatively confirmed by ultrasonographic and/or
 computed tomographic evidence.

 Exclusion Criteria:

 -  Suspicious diagnosis of appendicitis which was not in accordance with the diagnosis
 criteria.

 -  Patients who were subjected to ≥ 2 days of empirical antibiotics therapy for initial
 symptom prior to diagnosis with acute appendicitis.

 -  History of coagulation disorders, shock upon admission, previous abdominal surgery,
 contraindication to general anesthesia, suspected or proven malignancy, and mental
 illness.