64693
document
A prospective , randomized controlled trial of single-incision laparoscopic vs conventional 3-port laparoscopic appendectomy for treatment of acute appendicitis . BACKGROUND Proponents of single-incision laparoscopic surgery ( SILS ) claim patients have less pain , faster recovery , and better long-term cosmetic results than patients who undergo multiport laparoscopy . However , randomized comparisons are lacking . This study presents the results of a prospective randomized trial of SILS or 3-port laparoscopic appendectomy . STUDY DESIGN Adults with uncomplicated acute appendicitis were randomized 1:1 to either SILS or 3-port laparoscopic appendectomy . The primary end point was early postoperative pain ( measured by opiate usage and pain score in the first 12 hours ) . Secondary end points were operative time , complication rate ( including conversions ) , and recovery time ( days of oral opiate usage and return to work ) . After 6 months , body image and cosmetic appearance were assessed using a validated survey . RESULTS The trial was planned for 150 patients , but was halted after 75 patients when planned interim analysis showed that SILS patients had more postoperative pain ( pain score : 4.4 ± 1.6 vs 3.5 ± 1.5 ; p = 0.01 ) and higher inpatient opiate usage ( hydromorphone use : 3.9 ± 1.9 mg vs 2.8 ± 1.7 mg ; p = 0.01 ) than 3-port laparoscopy . Operative time for SILS averaged 40 % longer ( 54 ± 17 minutes vs 38 ± 11 minutes ; p < 0.01 ) . Only 1 SILS case was converted to 3-port . There were no significant differences in length of stay , complications , oral pain medication usage after discharge , or return to work . After 6 months , body image and cosmetic appearance were excellent for both groups and indistinguishable by most measures . However , 3-port patients reported better physical attractiveness ( 4.0 ± 0.4 vs 3.8 ± 0.4 ; p = 0.04 ) and SILS patients reported better scars ( score 18.4 ± 2.7 vs 16.4 ± 3.0 ; p < 0.01 ) . Results are reported as mean ± SD . CONCLUSIONS Single-incision laparoscopic surgery appendectomy resulted in more pain and longer operative times without improving short-term recovery or complications . Long-term body image and cosmetic appearance were excellent in both groups .
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Intervention_Surgical
single-incision laparoscopic
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Intervention_Surgical
conventional 3-port laparoscopic appendectomy
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Intervention_Surgical
single-incision laparoscopic surgery ( SILS )
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Intervention_Surgical
multiport laparoscopy
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Intervention_Surgical
SILS
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Intervention_Surgical
3-port laparoscopic appendectomy
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Intervention_Surgical
SILS
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Intervention_Surgical
3-port laparoscopic appendectomy
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Intervention_Surgical
SILS
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Outcome_Pain
early postoperative pain
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Outcome_Other
operative time ,
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Outcome_Adverse-effects
complication rate ( including conversions ) ,
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Outcome_Other
and recovery time ( days of oral opiate usage and return to work )
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Outcome_Mental
body image
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Outcome_Mental
cosmetic appearance
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Outcome_Pain
postoperative pain
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Participant_Age
Adults
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Participant_Condition
acute appendicitis
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Participant_Sample-size
150
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Participant_Sample-size
75
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Participant_Condition
postoperative pain