title: Two-Site Appendectomy in Children: Description of Technique and Outcomes.
abstract: OBJECTIVE
  Laparoscopic appendectomy is one of the most common operations. Single-site appendectomy has been gaining popularity; however, it has certain disadvantages. The purpose of this study was to review the results of an essentially scarless laparoscopic appendectomy technique.
  
  
  METHODS
  A retrospective review of all patients who underwent two-site appendectomy for appendicitis between January 2015 and February 2016 was performed. For all cases, a 4 mm trocar and a 5 mm trocar were placed through an infraumbilical incision and a 3 mm trocar was placed in the suprapubic region.
  
  
  RESULTS
  Fifty patients underwent appendectomy using this technique. The average age was 9.7 years (5-16 years) and average weight was 40 kg (15.7-73.3 kg). The classifications of appendicitis consisted of 32 simple, 5 suppurative, 4 gangrenous, and 8 perforated. The average operative time was 29 minutes (6-53 minutes) and average length of stay was 1.9 days (1-6 days). There were three minor complications, and all cases were completed with this technique, including in obese patients and for perforated appendicitis. All patients reported satisfaction with their postoperative cosmetic outcome.
  
  
  CONCLUSIONS
  This technique allows for the main incision to be hidden at the umbilicus, creating an essentially scarless cosmetic result. The addition of a 3 mm suprapubic port leads to increased maneuverability of the instruments and better retraction of the appendix. It is also feasible in obese children and cases of perforated appendicitis.
authors.affiliation: Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Slater
authors.affiliation: Rocky Mountain Hospital for Children , Denver, Colorado.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D001065:Appendix / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005734:Gangrene / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009765:Obesity / Q000150:complications; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus
keywords: appendectomy; appendicitis; pediatrics; single site; two site