title: Laparoscopy-assisted single-port appendectomy in children: is the postoperative infectious complication rate different?
abstract: OBJECTIVE
  In childhood, laparoscopy-assisted single-port appendectomy (SPA), including the advantages of open and laparoscopic surgery, is not widely used. However, there is debate whether the retrieval of the infected appendix via the umbilicus results in a higher infection rate compared with other laparoscopic or open techniques. The aim of the study was to determine the postoperative infection rate and possible risk factors for infection after SPA in children.
  
  
  METHODS
  For this retrospective study, case notes of all children (n = 262) who underwent SPA between August 2005 and December 2008 were reviewed. Those children in whom the preoperative ultrasonography revealed suspected perforation were excluded from SPA and subsequently underwent open surgery. SPA was performed using a 12-mm trocar with one 5-mm working channel, introduced through a sub-umbilical incision. After grasping the appendix with atraumatic forceps, the appendix was exteriorized through the umbilicus and dissected outside the abdominal cavity as in open surgery. Preoperatively, each patient received one dose of Metronidazole and Cefuroxime, and the umbilicus was cleaned in particular.
  
  
  RESULTS
  Of the 262 children who underwent SPA, 146 were boys (55.7%) and 116 girls (44.3%). Median age at operation was 11.4 years (range, 1.1-15.9). Six obese (with a body mass index greater than the 95th percentile) children (2.3%) developed intra-abdominal abscess after perforated appendicitis that was treated with a course of antibiotics. One child required revisional surgery and drainage. The median length of antibiotic treatment was 3 days (range, 0-15).
  
  
  CONCLUSIONS
  In our institution, SPA is the method of choice for appendectomy in children with acute appendicitis, in whom preoperative ultrasound does not reveal signs of perforation. The infection rate (2.7%) after SPA is not increased compared with other laparoscopic or open techniques. Overweight (body mass index greater than the 95th percentile) and perforated appendicitis seem to increase the risk of postoperative infectious complications.
authors.affiliation: Department of Paediatric Surgery, University Children's Hospital Basle (UKBB), Basle, Switzerland. sergio.sesia@ukbb.ch
authors.forename: Sergio B
authors.initials: SB
authors.lastname: Sesia
authors.forename: Frank-Martin
authors.initials: FM
authors.lastname: Haecker
authors.forename: Rainer
authors.initials: R
authors.lastname: Kubiak
authors.forename: Johannes
authors.initials: J
authors.lastname: Mayr
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods; D001064:Appendicitis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D016896:Treatment Outcome; D014472:Umbilicus