The aim of the current study was to perform a multicentered prospective double-blinded randomized controlled trial comparing laparoendoscopic single-site access (LESS) versus conventional three-port laparoscopic appendectomy (TPLA).
The clinical benefits and disadvantages of LESS appendectomy are uncertain.
Between October 2009 and March 2011, consecutive patients admitted with clinical or radiological evidence of appendicitis were randomly assigned to receive either LESS or TPLA. The main outcome measurement was overall pain score. Secondary outcome measurements included operative time, conversion rates, morbidity rates, activity pain scores, activity scores, patient satisfaction, and cosmesis scores.
During the study period, 200 patients were recruited to the study. There were no significant differences in the morbidity rates, operative time, conversion rates, and postoperative recovery. There were also no differences in the overall pain score and pain score at rest. However, patients in the LESS group experienced significantly more pain upon coughing or standing and required more intravenous analgesics (P = 0.001, 0.038, and 0.035, respectively). Wound cosmesis and satisfaction scores on the contrary were better in the LESS group (P = 0.002 and P = 0.052). No differences in the quality-of-life assessments were present at 2 weeks after operation.
LESS and conventional appendectomy resulted in similar perioperative outcomes. However, LESS appendectomy resulted in worst pain scores upon exertion and required a higher dosage of intravenous analgesics when compared with TPLA. On the contrary, wound cosmesis and satisfaction scores were better in the LESS group. Hence, adoption of the technique for appendectomy will depend on patient preferences and the presence of local expertise.
In this study comparing laparoendoscopic single-site access (LESS) appendectomy with conventional 3-port appendectomy, the LESS approach resulted in worse pain scores upon exertion and required a higher dosage of intravenous analgesics. However, wound cosmesis and satisfaction scores were better in the LESS group.
*Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin
†Department of Surgery, North District Hospital, Sheung Shui, Hong Kong.
Reprints: Enders Kwok Wai, Ng, FRCS (Edin), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 30–32, Ngan Shing Street, Shatin, New Territories, Hong Kong. E-mail: firstname.lastname@example.org.
Disclosure: The authors declare no conflicts of interest.
Trial registration: clinicaltrials.gov identifier NCT01203566.
This paper was accepted for oral presentation in the 97th Annual Clinical Congress of American College of Surgeons 2011.