title: Suprapubic single-incision laparoscopic appendectomy: a nonvisible-scar surgical option.
abstract: BACKGROUND
  At the present time, and given the increasing concern about body image, laparoscopic surgeons are faced with an increasing number of patients who want to conserve the umbilicus free of scars for cosmetic reasons. Single-incision laparoscopic surgery (SILS) using the suprapubic approach for appendectomy, while keeping the advantages of SILS through an umbilical incision, leaves the visible abdomen without scars. Moreover, insertion of an additional port in patients with retrocecal or purulent or gangrenous acute appendicitis requiring intra-abdominal drainage is avoided. This report describes the initial experience with suprapubic SILS appendectomy.
  
  
  METHODS
  Between September 2009 and December 2010, patients with acute appendicitis admitted to the General Surgery and Emergency Unit of the authors' institution and who agreed to undergo SILS appendectomy through the suprapubic approach were included in a prospective study. Demographics, clinical characteristics, and surgical outcome were recorded.
  
  
  RESULTS
  A total of 20 patients (12 men and 8 women) with a mean age of 30 ± 3 years underwent suprapubic SILS appendectomy. The mean duration of the operation was 40 ± 7 min. Placement of a suction drain was necessary in four patients. The mean length of hospital stay was 2 ± 0.5 days. The operation was completed successfully in all patients, and conversion to either multiport or open surgery was not required. No intraoperative or postoperative complications occurred. In all patients, the appearance of the suprapubic wound was good at 7 days after surgery.
  
  
  CONCLUSIONS
  Suprapubic SILS appendectomy offers better, cosmetically appealing results than the standard umbilical access. In case of retrocecal or purulent or gangrenous acute appendicitis, the view provided via the suprapubic approach makes access to and dissection of the appendix easy, and it also enables exteriorization of a drain without adding new lateral incisions.
authors.affiliation: General Surgery and Emergency Unit, Department of General and Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Villarroel 170, 9th stair, 4th floor, 08036 Barcelona, Spain. ovidal@clinic.ub.es
authors.forename: Oscar
authors.initials: O
authors.lastname: Vidal
authors.forename: Cesar
authors.initials: C
authors.lastname: Ginestà
authors.forename: Mauro
authors.initials: M
authors.lastname: Valentini
authors.forename: Josep
authors.initials: J
authors.lastname: Martí
authors.forename: Guerson
authors.initials: G
authors.lastname: Benarroch
authors.forename: Juan C
authors.initials: JC
authors.lastname: García-Valdecasas
mesh_terms: D000005:Abdomen; D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D004954:Esthetics; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011446:Prospective Studies; D013396:Suction / Q000706:statistics & numerical data