Single-incision multiport laparoscopy does not cause more pain than conventional laparoscopy: a prospective evaluation in children undergoing appendectomy.

Abstract

BACKGROUND:

The benefit of single-incision multiport laparoscopy (SIMPL) remains a matter of vivid discussion. For good reason it has been speculated that SIMPL causes more postoperative pain, because a minilaparotomy is required to place the multiport system. We prospectively evaluated postoperative pain scores and requirement of analgesic medication following conventional laparoscopic (CL) versus SIMPL appendectomy in children.

METHODS:

The access for laparoscopic appendectomy was decided upon the surgeon's preference. Between April and October 2010, individual abdominal pain scores at 8, 16, 24, 48, and 72 hours postoperatively as well as the incidence of umbilical or shoulder pain and the total amount of peri- and postoperative analgesics, operative time, length of hospital stay, and demographics were assessed. Analgesics (paracetamol and/or metamizole, 15 mg/kg body weight) were administered regularly or on inquiry of the patient. Data are presented as means±standard deviation tested at a significance level of P<.05.

RESULTS:

All operations were laparoscopically completed without conversion or addition of extra ports. Thirty-nine patients (8 SIMPL appendectomy) at a mean age of 12.3±2.4 years and a mean body mass index of 19.16±3.2 kg/m(2) were included. Equal operation times were observed (SIMPL: 68.5±19.9 minutes versus CL: 66.2±19.5 minutes). There were no significant differences for the individual pain scores or the incidence of umbilical and shoulder pain between study groups. The total amount of required analgesic medication was significantly lower after SIMPL appendectomy (SIMPL: 65.73±43.8 mg/kg versus CL: 106.39±46.4 mg/kg, P=.04).

CONCLUSION:

In summary, the present study substantiates the evidence that SIMPL appendectomy in children and adolescents is not only feasible but also beneficial for the patient without translation into increased postoperative pain. Presently, we are conducting a randomized, blinded study to validate these findings.

• Authors: Steffi Mayer, Antje Werner, Robin Wachowiak, Ulf Buehligen, Roland Boehm, Christian Geyer, Holger Till
• Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A (J Laparoendosc Adv Surg Tech A) Vol. 21 Issue 8 Pg. 753-6 (Oct 2011) ISSN: 1557-9034 [Electronic] United States
• PMID: 21777062 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Analgesics

Topics

• Abdominal Pain (etiology)
• Adolescent
• Analgesics (therapeutic use)
• Appendectomy (methods)
• Child
• Female
• Humans
• Laparoscopy (adverse effects, methods)
• Male
• Pain Measurement
• Pain, Postoperative (drug therapy, etiology)