Two-Port Versus Three-Port Laparoscopic Appendectomy In Children

Background/Purpose: Laparoscopic appendectomy is the routine technique for management of acute appendicitis in children in many centers. In this study, the classic three-port technique is compared to the two-port technique in the noncomplicated non-difficult acute appendicitis. Materials & Methods: This is a retrospective study of the cases of non-complicated acute appendicitis treated laparoscopically between June 2003 and June 2009. Cases treated by the two-and three -port techniques were compared regarding the operative duration, operative and postoperative complications and the length of hospital stay. Results: During the study period, 85 children (45 males and 40 females) had laparoscopic appendectomy for acute noncomplicated appendicitis; 48 children by the Three-port technique (group I) and 37 children by the Two-port technique (group II).The mean age was 9.7 years (range 4 – 13). The mean operative duration was 40 minutes (range 30-70) in group I and 25 minutes in group II (range 17-35). Operative bleeding occurred in 9 cases (19%) (group I) and 8 cases (22%) group II, operative rupture of the appendix in 1(2%) , Port site infection (redness or discharge) in 3 (6%) in group I and none in group II, Postoperative ileus ( > 48 hours) 3 (6%) in group I and 1(2.7%) in group II. The mean length of hospital stay was 2.3 days in group I and 2 days in group II. Three cases in group II were converted to total laparoscopic appendectomy because of residual long stump (conversion rate 8%). Conclusion: The Two-port laparoscopic appendectomy had less operative duration and length of hospital stay than the threeport technique in non-complicated non-difficult acute appendicitis in children. However, the operative and post operative complications were almost the same.Index Word: Laparoscopy, appendectomy