title: A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy.
abstract: 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.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Anthony Yuen Bun
authors.initials: AY
authors.lastname: Teoh
authors.forename: Philip Wai Yan
authors.initials: PW
authors.lastname: Chiu
authors.forename: Tiffany Cho Lam
authors.initials: TC
authors.lastname: Wong
authors.forename: Michael Chi Ming
authors.initials: MC
authors.lastname: Poon
authors.forename: Simon Kin Hung
authors.initials: SK
authors.lastname: Wong
authors.forename: Heng Tat
authors.initials: HT
authors.lastname: Leong
authors.forename: Paul Bo San
authors.initials: PB
authors.lastname: Lai
authors.forename: Enders Kwok Wai
authors.initials: EK
authors.lastname: Ng
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies