title: 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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Steffi
authors.initials: S
authors.lastname: Mayer
authors.forename: Antje
authors.initials: A
authors.lastname: Werner
authors.forename: Robin
authors.initials: R
authors.lastname: Wachowiak
authors.forename: Ulf
authors.initials: U
authors.lastname: Buehligen
authors.forename: Roland
authors.initials: R
authors.lastname: Boehm
authors.forename: Christian
authors.initials: C
authors.lastname: Geyer
authors.forename: Holger
authors.initials: H
authors.lastname: Till
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D001062:Appendectomy / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000700:Analgesics