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RESEARCH ARTICLE
Single-incision Laparoscopy-assisted Appendectomy in the

Pediatric Age Group: Our Experience

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Charu Tiwari , Hemanshi Shah , Gursev Sandlas , Neha Sisodiya Shenoy , Suraj Gandhi 5
AbstrAct
Background: Various methods of laparoscopic appendectomy have been described in children. We present the data of 50 children who underwent
interval appendectomy at our institution by transumbilical single-incision laparoscopy-assisted appendectomy (SILAA).
Materials and methods: Fifty patients <12 years from June 2011 to June 2017 with inclusion criteria <12 years of age who were admitted with
clinical features of acute appendicitis of >24–48 hours’ duration; had abdominal ultrasound (USG) with appendicular diameter of >10 mm
and good clinical response to initial management by intravenous antibiotics within 24–48 hours of admission were retrospectively analyzed.
They underwent SILAA after 6 weeks. Under general anesthesia, an infraumbilical incision was made and umbilical tube was identified. A 5
mm camera port was inserted by open Hassan’s technique. After visualizing the appendix, another incision was made adjacent to the port
site on the left and a 5 mm instrument was introduced through this. The appendix was freed, mobilized, and delivered through the incision.
Appendectomy was completed extracorporeally.
Results: The average age at presentation was 9.3 years. There were 18 females and 32 males. Two patients required conversion to open procedure
in view of extensive adhesions and a short retrocecal appendix which was difficult to mobilize and exteriorize through umbilicus. The mean
operating time was 30 minutes. There were no complications.
Conclusion: Single-incision laparoscopy-assisted appendectomy combines the advantages of both laparoscopic and open appendectomy and
offers reduced operative time and less complications and reduced surgical costs in pediatric age group.
Keywords: Appendectomy, Laparoscopy, Pediatric, Single incision.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1406

IntroductIon 1 Department of Paediatric Surgery, All India Institute of Medical

Appendiceal pathology accounts for approximately 15–20% Sciences, Raipur, Chhattisgarh, India; Department of Paediatric
of all abdominal surgical emergencies in the pediatric age Surgery, Topiwala National Medical College and BYL Nair Hospital,
group. 1–3 It has been regarded as the commonest indication Mumbai, Maharashtra, India
for appendectomy in pediatric patients. 1,4,5 Appendectomy is 2–5 Department of Paediatric Surgery, Topiwala National Medical
performed by various techniques, such as open, laparoscopic College and BYL Nair Hospital, Mumbai, Maharashtra, India
assisted, laparoscopic multiport, and single-incision laparoscopic Corresponding Author: Hemanshi Shah, Department of Paediatric
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approach. Laparoscopic appendectomy has been accepted as the Surgery, Topiwala National Medical College and BYL Nair Hospital,
gold standard for the management of appendicitis in children; its Mumbai, Maharashtra, India, e-mail: hemanshisshah@gmail.com
advantages over open appendectomy being less surgical trauma, How to cite this article: Tiwari C, Shah H, Sandlas G, et al. Single-
less postoperative pain, fewer postoperative infections, shorter incision Laparoscopy-assisted Appendectomy in the Pediatric Age
hospitalization, better cosmesis, and earlier recovery. 7 Group: Our Experience. World J Lap Surg 2020;13(2):77–79.

The conventional laparoscopic appendectomy uses three ports Source of support: Nil
for appendectomy. Appendectomy by a single incision is a further Conflict of interest: None
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evolution toward minimally invasive surgery. We present the
data of 50 children who underwent interval appendectomy at our Patients who presented within 24–48 hours of onset of their
institution by transumbilical single-incision laparoscopy-assisted symptoms, had uncomplicated appendicitis with appendicular
appendectomy (SILAA). diameter of 6–10 mm on USG, resolution of their symptoms with

MAterIAls And Methods intravenous antibiotics within 24–48 hours of admission, and no
recurrence of symptoms were excluded from this study. They were
We present our experience with SILAA in 50 pediatric patients <12 kept on vigilant follow-up. Patients presenting with appendicular
years from June 2011 to June 2017. perforation and abscess and having inadequate response to
Inclusion criteria were children <12 years of age who were intravenous antibiotics within 24 hours of admission underwent
admitted with clinical features of acute appendicitis of >24–48 emergency appendectomy and therefore excluded from this study.
hours’ duration; clinical evidence of acute appendicitis, abdominal All patients with acute abdominal pain with clinical diagnosis
ultrasound (USG) with appendicular diameter of >10 mm, and good of acute appendicitis underwent abdominal USG to rule out
clinical response to initial management by intravenous antibiotics complications, such as perforation or abscess. Appendicular
within 24–48 hours of admission. diameter was assessed on USG. In equivocal cases, computerized

© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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