Real-world data of single-incision laparoscopic appendectomy: a German-wide prospective cohort study among 276 individuals

Abstract

Background: Acute appendicitis is a common surgical emergency, with a lifetime risk of 8.6% in men and 6.7% in women. The standard of care is appendectomy, which can be performed using a single-incision laparoscopic approach. The evidence on single-incision laparoscopic appendectomy (SILA) is predominantly based on randomized controlled trials, often excluding patients with comorbidities or complex clinical profiles. This study aimed to generate real-world data (RWD) on adult patients undergoing SILA to assess its safety, feasibility, and clinical outcomes in routine practice. In addition, the study aimed to identify patient-specific risk factors for intraoperative and postoperative complications.

Methods: Data were obtained from the prospective multicenter SILAP registry, which included adult patients (≥18 years) who underwent SILA between January 2012 and April 2016. Demographic and clinical data including perioperative outcomes, were collected. Inclusion criteria comprised the ability and willingness to provide informed consent, while exclusion criteria included participation in other interventional studies. A descriptive comparison with high-volume studies was performed, focusing on key perioperative outcomes, including complication rates, operative time, length of hospital stay, mortality, and conversion rate.

Results: A total of 276 patients from 14 different hospitals in Germany who underwent SILA were included. The mean operative time was 50.9 minutes (standard deviation [SD] ± 27.6). The average postoperative length of stay was 3.6 days (SD ± 4.3), and the mortality rate was 0%. Intraoperative complications occurred in 1.8%, while 6.2% had postoperative complications. No significant associations were found between sex, age, body mass index, and American Society of Anesthesiologists classification and perioperative complications. In 96.4% of cases, the appendectomy was successfully completed using the single-incision technique.

Conclusion: SILA demonstrates safety and feasibility for managing acute appendicitis in routine clinical practice. The RWD supports outcomes of clinical trials. Further validation is required to confirm risk factors for complication of specific subgroups.

Keywords: appendectomy; appendicitis; development of complications; prospective multicenter observational study; single incision.