A double-blinded randomized controlled trial of laparoendoscopic single-site
access versus conventional 3-port appendectomy.
Author(s): Teoh AY, Chiu PW, Wong TC, Poon MC, Wong SK, Leong HT, Lai PB, Ng EK.
Affiliation(s): Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong
Kong, Shatin, Hong Kong.
Publication date & source: 2012, Ann Surg. , 256(6):909-14
OBJECTIVE: 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).
BACKGROUND: The clinical benefits and disadvantages of LESS appendectomy are
uncertain.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
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