Single incision extra-corporeal appendectomy compared to conventional multi-ports appendectomy: a case control study

Introduction: Single incision extra-corporeal appendectomy (SIEA) has emerged as an alternative to the conventional three port appendectomy (CLA). In this study we aim to demonstrate that single incision extracorporeal appendectomy (SIEA) is noninferior to conventional laparoscopic appendectomy (CLA) and more cost effective. Methods and procedures: The following study is a retrospective case-control study of patients who underwent either SIEA or CLA. Data obtained from both groups was analyzed in terms of demographics, comorbidities, symptoms, laboratory findings, Alvarado score, imaging findings, American society of Anesthesia (ASA) score, operative time, intraoperative findings, case performance by surgeon level, and outcomes as well as cost. Wilcoxon test was used to compare continuous data. Fischer’s exact test compared proportions. Significance was defined as p-value < 0.05. Results A total of 156 patients (27 SIEA vs. 129 CLA) were reviewed. SIEA and CLA were similar in mean age, gender, comorbidities, laboratory investigations, Alvarado score, image positivity, ASA score, and intraoperative findings (p > 0.05 for all). Outcomes were similar between the two groups with regards time to advancement of diet (median time 6 hours vs 6 hours), post-operative complications (wound infection, deep seated infections 3.7% vs 4.7%), and readmission rates (3.7% vs 2.3%) (p > 0.05 for all). Length of stay was slightly shorter in the SIEA than the CLA group, despite approaching statistical significance it was not clinically significant (mean 1.7 days vs 2 days p = 0.05). Operative time in SIEA was shorter than CLA (median time 50 min vs 75 min, (p < 0.001). When considering equipment cost, SIEA had a lower cost compared to CLA (mean cost 236 USD vs 632 USD). Conclusion SIEA is noninferior to CLA in terms of outcomes, however it is associated with at least 63% reduction in cost.