title: Laparoscopic Extracorporeal Appendectomy in Overweight and Obese Children.
abstract: OBJECTIVE
  To compare surgical outcomes of overweight and obese patients with acute appendicitis who have undergone single-port extracorporeal laparoscopically assisted appendectomy (SP) with those who have had conventional 3-port laparoscopic appendectomy (TP).
  
  
  METHODS
  This single-center retrospective chart review included patients 21 years of age and younger with a preoperative diagnosis of appendicitis who underwent laparoscopic appendectomy from January 2010 through December 2015. Cases of gangrenous and perforated appendicitis were excluded. Subgroup analyses of patients with acute appendicitis were performed. Operative time (OT), length of stay (LOS), and cost were compared between groups stratified by body mass index (BMI) and operative technique.
  
  
  RESULTS
  A total of 625 appendectomies were performed-457 for acute appendicitis. Sixty-eight patients were overweight. The SP technique (n = 30) had shorter OT (median minutes, 41 vs 68; P < .001), lower cost (median , $5741 vs $8530; P < .001), and shorter LOS (median hours, 16 vs 19; P = .045) than the TP technique had (n = 38). Seventy patients were obese: 19 were treated with SP and 51 with TP. LOS did not differ significantly between the SP and TP groups, but subjects treated with SP had shorter OT (median minutes, 39 vs 63; P < .001) and lower cost (median, $6401 vs $8205; P = .043).
  
  
  CONCLUSIONS
  The SP technique for acute appendicitis was found to have a significantly shorter OT and lower cost in all weight groups. There were minimal differences in LOS. SP should be considered in patients with acute appendicitis, regardless of their weight.
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Arathi
authors.initials: A
authors.lastname: Mohan
authors.affiliation: Duke Center for Metabolic and Weight Loss Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Alfredo D
authors.initials: AD
authors.lastname: Guerron
authors.affiliation: Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Karam
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Worley
authors.affiliation: Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
authors.forename: Federico G
authors.initials: FG
authors.lastname: Seifarth
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D050177:Overweight / Q000150:complications*; D063766:Pediatric Obesity / Q000150:complications*; D012189:Retrospective Studies
keywords: Appendectomy; Appendicitis; Laparoscopy; Obesity; Pediatrics