Aim. Laparoscopic-assisted single-port appendectomy (SPA), although combining the advantages of open and conventional laparoscopic surgery, is still not widely used in childhood. The aim of this study was to evaluate the safety and the cost effectiveness of SPA in children. Methods. After institutional review board approval, we retrospectively evaluated 262 children who underwent SPA. The appendix was dissected outside the abdominal cavity as in open surgery. For stump closure, we used two 3/0 vicryl RB-1 sutures. Results. We identified 146 boys (55.7%) and 116 girls (44.3%). Median age at operation was 11.4 years (range, 1.1–15.9). Closure of the appendiceal stump using two sutures (cost: USD 15) was successful in all patients. Neither a stapler (cost: USD 276) nor endoloops (cost: USD 89) were used. During a follow-up of up to 69 months (range, 30–69), six obese children (2.3%, body mass index >95th percentile) developed an intra-abdominal abscess after perforated appendicitis. No insufficiency of the appendiceal stump was observed by ultrasound. Five of them were treated successfully by antibiotics, one child required drainage. Conclusion. The SPA technique with conventional extracorporal closure of the appendiceal stump is safe and cost effective. In our unit, SPA is the standard procedure for appendectomy in children. 1. Introduction Since the first description of laparoscopic appendectomy by Semm in 1983 [1], several laparoscopic techniques have evolved to attain stump closure. Surgeons can choose between clip, stapler, endoloops [2, 3], or simple sutures as in open surgery. Commonly, endoloops or endostaplers are used for closing the stump of the appendix [3, 4]. We report about the cost of appendiceal stump closure using only sutures in laparoscopic-assisted single-port appendectomy (SPA) in children. 2. Materials and Methods After institutional review board approval, we retrospectively reviewed the medical records of children who underwent SPA between August 2005 and December 2008 at the University Children’s Hospital of Basle (UKBB). According to the World Organization of Gastroenterology Research Committee [5], diagnosis of acute appendicitis was made by comprehensive anamnesis, physical examination with particular attention of rebound tenderness on the right lower abdominal quadrant, supporting laboratory tests such as white blood cell count (WBC) and C-reactive protein (CRP), and ultrasound scan of the abdomen. All children admitted on our emergency room with suspected acute appendicitis were considered for SPA and included in this study.
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