Background
Methods
Children and clinical data
Data collection
Statistical analysis
Surgical techniques
Two-trocar technique
Three-trocar technique
Results
Patient characteristics
Two-trocar LA (N = 91) | Three-trocar LA (N = 168) | p-value | |
---|---|---|---|
Males/Females | 50/41 (55/45) | 94/75 (56/44) | 1.000c |
Age (years) | 10.3 ± 3.3 | 10.5 ± 2.8 | 0.652d |
Age group | |||
4 years | 5 (5) | 4 (2) | 0.293c |
5–9 years | 24 (27) | 47 (28) | 0.882c |
10–14 years | 62 (68) | 117 (70) | 0.881c |
Weight by age group (kg) | |||
4 years | 15 (15–17) | 16 (14–18) | X |
5–9 years | 27 (17–38) | 27 (14–45) | 0.966d |
10–14 years | 48 (24–72) | 50 (26–87) | 0.062d |
Time from admission to appendectomy (h) | 4 (1–41) | 4 (0.5–34) | 0.412c |
Duration of symptoms (h) | 24 (2–240) | 24 (3–168) | 0.314e |
CRP value (mg/L) | 12 (0–263)a | 21 (0–365)b | 0.071e |
Leucocytosis | 53 (58) | 93 (55) | 0.691c |
Fever > 38 °C | 32 (35) | 71 (42) | 0.294c |
Grade of inflammation | |||
Phlegmonous | 56 (92) | 114 (68) | 0.341c |
Gangrenous | 9 (10) | 21 (13) | 0.682c |
Perforated | 5 (5) | 14 (8) | 0.462c |
Negative appendectomy | 21 (23) | 19 (11) | 0.023c |
Long-term follow-up (months) | 47 ± 30 | 38 ± 28 | 0.023d |
Evaluation of the surgical technique
Two-trocar LA (N = 91) | Three-trocar LA (N = 168) | p-value | |
---|---|---|---|
Surgery time all included (min) | 47 ± 16 | 66 ± 22 | <0.001e |
Surgery time with negative appendectomies and patients with surgical complications excluded (min) | 46 ± 16 | 65 ± 20 | <0.001e |
Excluded patients | 23 (25) | 26 (15) | |
Surgery time > 60 min | 12 (13) | 86 (51) | <0.001d |
Surgery time in patients with surgical complications (min) | 46 ± 1 | 81 ± 20 | 0.003e |
Included patients | 7 (8) | 2 (1) | |
Number of surgical complications | 2a (2) | 7b (4) | 0.501d |
Number of postoperative complications | 0 (0) | 8c (5) | 0.054d |
Wound infection | 1 (1) | 1 (1) | 1.000d |
Two-trocar LA (N = 68) | Three-trocar LA (N = 135) | p-value | |
---|---|---|---|
Morphine administration | 15 (22) | 37 (27) | 0.502b |
Total amount of morphinea (mg/kg) | 0.11 ± 0.09 | 0.11 ± 0.09 | 0.744c |
NSAID administration | 38 (57) | 73 (54) | 0.772b |
Single doses | 25 (37) | 45 (33) | 0.644b |
Regular treatment | 13 (20) | 28 (21) | 1.000b |
Paracetamol intravenously (doses) | 2 (0–10) | 2 (0–18) | 0.914d |
Two-trocar LA | Three-trocar LA | |
---|---|---|
Advantages | • Less trauma • Only two scars on the abdomen • Shorter surgery time • Cheaper • Shorter learning curve | • More instruments in the abdomen • Diathermy • Can be used with adhesions or retrocecal appendix • More often applicable |
Disadvantages | • Only one instrument • Cannot use diathermy • Limited mobility in the abdominal cavity and less able to explore the intestinal package • Cannot get traction to resolve adhesions • Not always applicable | • Longer surgery time • More scars • More trauma |
Discussion
Study | Age group (N) | Trocar placement | Results |
---|---|---|---|
Valioulis et al. [13] No comparison. | Children (38) | Umbilicus and pubic symphysis | Success: 76 %, mean operation time 19 min, wound infection 3 %. |
Tekin and Kurtoglu [16] No comparison. | Adults (440) | Umbilicus and McBurney | Success: 67 %, mean operation time 46 min, wound infection 4 %. |
Konstadoulakis [17] Comparison with conventional LA. | Adults (37) | Left iliac fossa and McBurney | Success 80 %, mean operation time 48 min, wound infection 11 %. |
Malik et al. [18] Comparison with OA | Adults (14) | Umbilicus and McBurney | Success 11 %, mean operation time or wound infection not specified for two-trocar LA only. |
Yagnik et al. [21] Comparison with OA and conventional LA. | Adults (61) | Umbilicus and Mcburney | Success 100 %, mean operation time 36 min, wound infection 1 %. |
Baid et al. [20] Comparison with conventional LA | Adults (38) | Umbilicus and Mcburney | Success 84 %, mean operation time 24 min, wound infection 16 % |