Analyzing the conversion factors associated with switching from a single-incision, one-puncture procedure to a two-site, three-port procedure in pediatric laparoscopic appendectomy

摘要

Abstract Purpose We previously reported the safety and feasibility of single-incision, one-puncture laparoscopic appendectomy (SIOPLA). However, in some cases, we switched using to 5-mm forceps instead of 2.4-mm graspers and a 5-mm trocar because of severe adhesion and the appendix location. The present study investigated the factors associated with conversion from SIOPLA to two-site, three-port laparoscopic appendectomy (TTLA) in children.Methods Sixty-one pediatric laparoscopic appendectomies performed by a surgeon-in-training from 2017 and 2020 were registered. Patients’ background characteristics and clinical outcomes were compared to analyze the conversion factors.Results Forty-nine patients (80.3%) underwent SIOPLA, and 12 (19.7%) underwent TTLA. The illness period, preoperative body temperature (BT), CRP and size of the appendix were significantly greater with TTLA than with SIOPLA. Regarding the operative results, the operation time, time taken to expose the appendix and time taken to resect the appendix from to dissect mesoappendix (min) were significantly longer with TTLA than with SIOPLA (min; 98.7 ± 33.0 vs. 152 ± 45.1, p < 0.01; 16.9 ± 10.9 vs. 44.2 ± 18.1, p < 0.01; 23.0 ± 11.1 vs. 35.6 ± 20.6, p < 0.05, respectively). Regarding the pathological findings, the patients in the TTLA group all had gangrenous appendicitis.Conclusion Preoperative findings of gangrenous or complicated appendicitis were conversion factors for SIOPLA to TTLA.