Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 27;17(7):105925.
doi: 10.4240/wjgs.v17.i7.105925.

Feasibility of single-port laparoscopic appendectomy for retrocecal appendicitis: A propensity score-matched study with multi-port laparoscopic appendectomy

Sang-Ah Woo  1 , Seung Jae Roh  2 , Nak Song Sung  1 , Won Jun Choi  1
Affiliations

Feasibility of single-port laparoscopic appendectomy for retrocecal appendicitis: A propensity score-matched study with multi-port laparoscopic appendectomy

Sang-Ah Woo et al. World J Gastrointest Surg. .

Abstract

Background: Retrocecal appendicitis, the most common anatomical type, presents diagnostic and surgical challenges. Single-port laparoscopic appendectomy (SPLA) has been proposed as an alternative to multi-port laparoscopic appendectomy (MPLA) with advancements in minimally invasive surgery. However, few studies have compared the perioperative outcomes between the SPLA and MPLA for retrocecal appendicitis.

Aim: To compare the efficacy and safety between the SPLA and MPLA in treating retrocecal appendicitis, focusing on perioperative outcomes.

Methods: This retrospective study analyzed data from 1041 patients who underwent SPLA or MPLA at Konyang University Hospital between October 2011 and February 2023. Propensity score matching (PSM) was used to minimize selection bias, resulting in 235 patients in each group. Additionally, non-inferiority tests, post-hoc analysis, and multivariable regression analysis were performed to validate the results and assess factors affecting postoperative outcomes.

Results: After PSM, SPLA showed shorter operation time (43.8 ± 15.8 minutes vs 51.6 ± 18.7 minutes; P < 0.001) and lower estimated blood loss (EBL, 6.5 ± 7.8 mL vs 8.6 ± 8.3 mL; P < 0.001) than MPLA. No significant differences were observed in complications, pain scores, or length of hospital stay. SPLA was not inferior to MPLA in the main outcomes, except for the complication rate, where statistical power was insufficient. Multivariable regression confirmed SPLA as an independent factor for operation time and EBL.

Conclusion: SPLA is more feasible than MPLA for retrocecal appendicitis, offering advantages in operation time and estimated blood loss. This study supports SPLA as a viable alternative that enhances postoperative recovery.

Keywords: Laparoscopic appendectomy; Multi-port laparoscopic appendectomy; Propensity score matching; Retrocecal appendicitis; Single-port laparoscopic appendectomy.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1
Acute appendicitis located in retrocecal position. This figure is generated based on a case performed at Konyang University Hospital.
Figure 2
Figure 2
Flow charts of patient selection process. SPLA: Single-port laparoscopic appendectomy; MPLA: Multi-port laparoscopic appendectomy.
Figure 3
Figure 3
Postoperative surgical wound site after single-port laparoscopic appendectomy. This figure is generated based on a case performed at Konyang University Hospital.
Figure 4
Figure 4
Histogram for comparing operation time and estimated blood loss between the single-port laparoscopic appendectomy group and multi-port laparoscopic appendectomy group. A: Histogram of operation time for single-port laparoscopic appendectomy (SPLA); B: Histogram of operation time for multi-port laparoscopic appendectomy (MPLA); C: Histogram of estimated blood loss (EBL) for SPLA; D: Histogram of EBL for MPLA. SPLA: Single-port laparoscopic appendectomy; MPLA: Multi-port laparoscopic appendectomy; EBL: Estimated blood loss.
Figure 5
Figure 5
Non-inferiority test. A: Continuous variables; B: Categorical variables. SPLA: Single-port laparoscopic appendectomy; MPLA: Multi-port laparoscopic appendectomy; EBL: Estimated blood loss; OR: Odds ratio.
Figure 6
Figure 6
Post-hoc power analysis for postoperative outcomes. EBL: Estimated blood loss.
Figure 7
Figure 7
Forest plot for multivariable logistic regression comparing the single-port laparoscopic appendectomy and multi-port laparoscopic appendectomy groups.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Han Y, Yuan H, Li S, Wang WF. Single-incision versus conventional three-port laparoscopic appendectomy for acute appendicitis: A meta-analysis of randomized controlled trials. Asian J Surg. 2024;47:864–873. - PubMed
    1. Cirocchi R, Cianci MC, Amato L, Properzi L, Buononato M, Di Rienzo VM, Tebala GD, Avenia S, Iandoli R, Santoro A, Vettoretto N, Coletta R, Morabito A. Laparoscopic appendectomy with single port vs conventional access: systematic review and meta-analysis of randomized clinical trials. Surg Endosc. 2024;38:1667–1684. - PMC - PubMed
    1. Hosokawa T, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Oguma E. Association between the computed tomography findings and operative time for interval appendectomy in children. Afr J Paediatr Surg. 2021;18:73–78. - PMC - PubMed
    1. Khatun S, Thakur D, Shah DK. Prevalence of Retrocaecal Appendix among Patients with Appendicitis in A Tertiary Care Hospital of Nepal. JNMA J Nepal Med Assoc. 2019;57:150–153. - PMC - PubMed
    1. Singh N, Agrawal P, Singh DK, Agrawal GR. Computed tomography evaluation of variations in positions and measurements of appendix in patients with non-appendicular symptoms: time to revise the diagnostic criteria for appendicitis. Pol J Radiol. 2023;88:e407–e414. - PMC - PubMed

LinkOut - more resources