Single Incision Laparoscopic Appendectomy with Surgical-glove Port is Cost-effective and Reliable in Complicated Acute Appendicitis: A Casecontrol Multicenter Study in Colombia

Overview

Journal Heliyon

Specialty Social Sciences

Date 2023 Feb 7

PMID 36747929

Authors

Andres Felipe Carrillo Montenegro

Sofia Aristizabal Rojas

Jean Andre Pulido Segura

Mauricio Pedraza

Laura Padilla

Ivan David Lozada-Martinez

Alexis Rafael Narvaez-Rojas

Luis Felipe Cabrera-Vargas

Affiliations

Soon will be listed here.

Abstract

Background: The single-port (SPL) and multi-port (MPL) laparoscopic approach are the gold standard of management of acute appendicitis, due to its multiple advantages over open surgery, mainly because of its direct effects on recovery, esthetics and costs of the procedure. However, in third-world countries, the laparoscopic approach is not yet fully reproducible due to the costs of the technique. The surgical-glove port single incision laparoscopic appendectomy (SGP-SILA) has been proposed as a viable option. However, it has never been studied in Colombia.

Objective: To evaluate the cost-effectiveness and reliability of SGP-SILA in the management of complicated acute appendicitis, compared to traditional MPL approach.

Materials And Methods: A retrospective case control study was carried out comparing patients undergoing laparoscopic appendectomy by SGP-SILA vs. MPL, evaluating operating costs associated with intraoperative and postoperative variables in two tertiary centers in Bogota, Colombia. The data were analyzed and expressed according to their nature and distribution.

Results: 116 patients were included (SGP-SILA: 62 and MPL: 54). The median surgical time for SGP-SILA was 60 min vs. 39 min for MPL. SGP-SILA was shown to cause lower frequency of surgical site infection (4 vs. 8 patients; p = 0.047). It was found a significant correlation between Grade III surgical site infection and surgery time (p = 0.047) in the MPL group; also, with hospital stay (p < 0.001). Also, a lower risk of surgical site infection was found with the SGP-SILA technique (22% vs. 31%). SGP-SILA generated a reduction in both direct and indirect operating costs of approximately 10% (616 USD vs. 683 USD).

Conclusion: SGP-SILA and MPL are feasible and comparable procedures in the resolution of complicated acute appendicitis. SGP-SILA turns out to be more cost-effective compared to MPL, due to the use of more easily accessible instruments. This may be a reproducible technique in low- and middle-income countries.

Citing Articles

Single-incision laparoscopic appendectomy versus traditional three-hole laparoscopic appendectomy for acute appendicitis in children by senior pediatric surgeons: a multicenter study from China.

Liu J, Chen G, Mao X, Jiang Z, Jiang N, Xia N Front Pediatr. 2023; 11:1224113.

PMID: 37492606 PMC: 10364637. DOI: 10.3389/fped.2023.1224113.

References

Mandrioli M, Inaba K, Piccinini A, Biscardi A, Sartelli M, Agresta F . Advances in laparoscopy for acute care surgery and trauma. World J Gastroenterol. 2016; 22(2):668-80. PMC: 4716068. DOI: 10.3748/wjg.v22.i2.668. View

Aly O, Black D, Rehman H, Ahmed I . Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: A systematic review and meta-analysis. Int J Surg. 2016; 35:120-128. DOI: 10.1016/j.ijsu.2016.09.087. View

Chatterjee A, Payette M, Demas C, Finlayson S . Opportunity cost: a systematic application to surgery. Surgery. 2009; 146(1):18-22. DOI: 10.1016/j.surg.2009.03.027. View

Snyder M, Guthrie M, Cagle S . Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018; 98(1):25-33. View

Uday S, Bhargav P . SILACIG: A novel technique of single-incision laparoscopic appendicectomy based on institutional experience of 29 cases. J Minim Access Surg. 2013; 9(2):76-9. PMC: 3673578. DOI: 10.4103/0972-9941.110967. View

Que Son Sr T, Hoc T, Long V, Tung T, Tuan N, Minh Hue B . Laparoscopic Appendectomy Using the Surgical-Glove Port Through an Umbilical Incision: A Single-Center Retrospective Study. Cureus. 2022; 14(4):e24512. PMC: 9042655. DOI: 10.7759/cureus.24512. View

Sesia S, Berger E, Holland-Cunz S, Mayr J, Hacker F . Laparoscopy-Assisted Single-Port Appendectomy in Children: Safe Alternative also for Perforated Appendicitis?. Medicine (Baltimore). 2015; 94(50):e2289. PMC: 5058934. DOI: 10.1097/MD.0000000000002289. View

St Peter S, Adibe O, Juang D, Sharp S, Garey C, Laituri C . Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg. 2011; 254(4):586-90. DOI: 10.1097/SLA.0b013e31823003b5. View

Gorter R, Eker H, Gorter-Stam M, Abis G, Acharya A, Ankersmit M . Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016; 30(11):4668-4690. PMC: 5082605. DOI: 10.1007/s00464-016-5245-7. View

10.

Liu X, Li J, Shi G, Guo R, Zhang R . Systematic review of single-incision versus conventional multiport laparoscopic surgery for sigmoid colon and rectal cancer. World J Surg Oncol. 2018; 16(1):220. PMC: 6230377. DOI: 10.1186/s12957-018-1521-4. View

11.

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61(4):344-9. DOI: 10.1016/j.jclinepi.2007.11.008. View

12.

Meara J, Leather A, Hagander L, Alkire B, Alonso N, Ameh E . Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015; 386(9993):569-624. DOI: 10.1016/S0140-6736(15)60160-X. View

13.

Nazir A, Farooqi S, Chaudhary N, Bhatti H, Waqar M, Sadiq A . Comparison of Open Appendectomy and Laparoscopic Appendectomy in Perforated Appendicitis. Cureus. 2019; 11(7):e5105. PMC: 6728774. DOI: 10.7759/cureus.5105. View

14.

Nunez-Gamez J, Medina-Bravo P, Pineros-Lopez N, Contreras G, Rosero-Burgos M, Lozada-Martinez I . Global outcomes, surgical teams and COVID-19 pandemic: Will the same objectives of global surgery persist?. Ann Med Surg (Lond). 2021; 71:103002. PMC: 8556179. DOI: 10.1016/j.amsu.2021.103002. View

15.

Bae S, Jeong W, Baek S . Single-Port Laparoscopic Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess. Ann Coloproctol. 2016; 32(3):105-10. PMC: 4942525. DOI: 10.3393/ac.2016.32.3.105. View

16.

Silva-Rued M, Ramirez-Romero A, Guerra-Maestre L, Forero-Hollmann A, Lozada-Martinez I . The need to develop specialized surgical centers: the evidence that surgical diseases cannot wait. Int J Surg. 2021; 92:106036. PMC: 8321957. DOI: 10.1016/j.ijsu.2021.106036. View

17.

Gomes C, Sartelli M, Podda M, Di Saverio S, Coccolini F, Segovia-Lohse H . Laparoscopic versus open approach for diffuse peritonitis from appendicitis ethiology: a subgroup analysis from the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study. Updates Surg. 2020; 72(1):185-191. DOI: 10.1007/s13304-020-00711-y. View

18.

Li X, Zhang Q, Zhang W, Liu T . Mini-Incision Open Appendectomy with Incision Skin Tissue Retractor vs. Laparoscopic Appendectomy: A Retrospective Study of the Management of Child Acute Appendicitis. Adv Ther. 2018; 35(12):2176-2185. PMC: 6267690. DOI: 10.1007/s12325-018-0829-3. View

19.

Di Saverio S, Mandrioli M, Birindelli A, Biscardi A, Di Donato L, Gomes C . Single-Incision Laparoscopic Appendectomy with a Low-Cost Technique and Surgical-Glove Port: "How To Do It" with Comparison of the Outcomes and Costs in a Consecutive Single-Operator Series of 45 Cases. J Am Coll Surg. 2016; 222(3):e15-30. DOI: 10.1016/j.jamcollsurg.2015.11.019. View

20.

Muneef A, Kumbhar U, Vijayakumar C, Shaikh O . A Comparative Study Between Single-Incision Laparoscopic Appendicectomy Using Conventional Instruments and Glove-Port (SILACIG) and Conventional Multiport Laparoscopic Appendicectomy (CMLA). Cureus. 2020; 12(10):e11257. PMC: 7707898. DOI: 10.7759/cureus.11257. View