Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery

Abstract

Purpose: Conventional laparoscopic appendectomy is performed using three ports, and single-port appendectomy is an attractive alternative in order to improve cosmesis. The aim of this study was to compare pain after transumbilical single-port laparoscopic appendectomy (SA) with pain after conventional three-port laparoscopic appendectomy (TA).

Methods: From April to September 2011, 50 consecutive patients underwent laparoscopic appendectomy for simple appendicitis without gangrene or perforation. Patients who had undergone appendectomy with a drainage procedure were excluded. The type of surgery was chosen based on patient preference after written informed consent was obtained. The primary endpoint was postoperative pain evaluated by the visual analogue scale score and postoperative analgesic use. Operative time, recovery of bowel function, and length of hospital stay were secondary outcome measures.

Results: SA using a SILS port (Covidien) was performed in 17 patients. The other 33 patients underwent TA. Pain scores in the 24 hours after surgery were higher in patients who underwent SA (P = 0.009). The change in postoperative pain score over time was significantly different between the two groups (P = 0.021). SA patients received more total doses of analgesics (nonsteroidal anti-inflammatory drugs) in the 24 hours following surgery, but the difference was not statistically significant. The median operative time was longer for SA (P < 0.001).

Conclusion: Laparoscopic surgeons should be concerned about longer operation times and higher immediate postoperative pain scores in patients who undergo SA.

Keywords: Appendicitis; Laparoscopic appendectomy; Postoperative pain; SILS port; Single incision.

Fig. 1

Transumbilical single-port laparoscopic appendectomy (SA). (A) Preoperative view. (B) A longitudinal umbilical incision about 20 mm in length. (C) The SILS port was inserted into the umbilical incision. (D) External view during SA. (E) The mesoappendix was first divided using ultrasonic shears. (F) The base of the appendix was ligated using a round loop. (G, H) The resected appendix was removed with the aid of a bag.

Fig. 2

Postoperative pain score on the visual analogue scale according to the number of ports as a function of time after laparoscopic appendectomy. ^a)Pain in the 24 hours after surgery was higher in patients who underwent transumbilical single-port laparoscopic appendectomy (P = 0.009; corrected by Bonferroni's method).

Fig. 3

The change in the visual analogue scale pain score as a function of postoperative time was significantly different between the two groups (P = 0.021 by repeated measures analysis of variance).

Fig. 4

Example of cosmetic results in this study. (A) At the time of closure. (B) Seven days postoperatively.