title: Feasibility of single-incision laparoscopic surgery for appendicitis in abnormal anatomical locations: A single surgeon's initial experience.
abstract: BACKGROUND
  Single-incision laparoscopic surgery is considered as a more technically demanding procedure than the standard laparoscopic surgery. Based on an initial and early experience, single-incision laparoscopic appendectomy (LA) was found to be technically advantageous for dealing with appendicitis in unusual anatomical locations. This study aims to highlight the technical advantages of single-incision laparoscopic surgery in dealing with the abnormally located appendixes and furthermore report a case of acute appendicitis occurring in a sub-gastric position, which is probably the first such case to be reported in English literature.
  
  
  METHODS
  A retrospective analysis of the first 10 cases of single-incision LA which were performed by a single surgeon is presented here.
  
  
  RESULTS
  There were seven females and three males. The mean age of the patients was 30.6 (range 18-52) years, mean BMI was 22.7 (range 17-28) kg/m(2) and the mean operative time was 85.5 (range 45-150) min. The mean postoperative stay was 3.6 (range 1-7) days. The commonest position of the appendix was retro-caecal (50%) followed by pelvic (30%). In three cases the appendix was found to be in abnormal locations namely sub-hepatic, sub-gastric and deep pelvic or para-vesical or para-rectal. All these cases could be managed with this technique without any conversions.
  
  
  CONCLUSIONS
  Single-incision laparoscopic surgery appears to be a feasible and safe technique for dealing with appendicitis in rare anatomical locations. Appendectomy may be a suitable procedure for the initial training in single-incision laparoscopic surgery.
authors.affiliation: Department of General, Gastrointestinal and Laparoscopic Surgery, M.O.S.C Medical College, Kolenchery, Cochin, Kerala, India.
authors.forename: Sanoop K
authors.initials: SK
authors.lastname: Zachariah
keywords: Appendectomy; Single-incision laparoscopy; left-sided appendicitis; sub-gastric appendix; sub-hepatic appendix