title: Two-trocar appendectomy in children - description of technique and comparison with conventional laparoscopic appendectomy.
abstract: BACKGROUND
  The aim of the study was to describe the technique of two-trocar laparoscopic appendectomy and compare the outcome between two- and three-trocar techniques in children.
  
  
  METHODS
  All children who underwent laparoscopic surgery for suspected appendicitis from 2006 to 2014 in a center for pediatric surgery were included in the study. Converted surgeries and patients with appendiceal abscess or concomitant intestinal obstruction were excluded. A total of 259 children underwent appendectomy with either two (35 %) or three (65 %) laparoscopic trocars according to the surgeons' preference and intraoperative judgment. Patient demographics, clinical symptoms, surgery characteristics, and complications were reviewed.
  
  
  RESULTS
  The mean age of the children was 10.4 years (range, 1-14 years). The mean follow-up time was 41.2 months (SD ± 29.2). No significant differences in age, gender, weight, or signs and symptoms were found between the two- and three-trocar groups. The mean surgery time was significantly shorter in the two-trocar group (47 min) than in the three-trocar group (66 min; p < 0.001). The rates of surgical complications were 2 % vs. 4 %, (p = 0.501), and the rates of postoperative complications were 0 % vs. 5 % (p = 0.054), in the two- and three-trocar groups. The overall incidence of postoperative wound infection was low (<1 %) and did not differ between groups.
  
  
  CONCLUSIONS
  Two-trocar laparoscopic appendectomy seems to be a safe and feasible technique with a low rate of postoperative wound infections. The present findings demonstrate that when the two-trocar technique could be applied, it is a good complement to the conventional three-trocar technique.
authors.affiliation: Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden. martin.salo@med.lu.se.
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0002-6617-6784
authors.initials: M
authors.lastname: Salö
authors.affiliation: Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden.
authors.forename: Emil
authors.initials: E
authors.lastname: Järbur
authors.affiliation: Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden.
authors.forename: Mette
authors.initials: M
authors.lastname: Hambraeus
authors.affiliation: Department of Clinical Sciences, and Division of Internal Medicine, Lund University, Skåne University Hospital, Malmö, 205 02, Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Ohlsson
authors.affiliation: Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Stenström
authors.affiliation: Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden.
authors.forename: Einar
authors.initials: E
authors.lastname: Arnbjörnsson
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D013525:Surgical Instruments; D013530:Surgical Wound Infection / Q000453:epidemiology
keywords: Acute abdomen; Appendectomy; Appendicitis; Children; Laparoscopy