Two-trocar appendectomy in children - description of technique and comparison with conventional laparoscopic appendectomy.
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.
['Salö|Martin|M|http://orcid.org/0000-0002-6617-6784', 'Järbur|Emil|E|', 'Hambraeus|Mette|M|', 'Ohlsson|Bodil|B|', 'Stenström|Pernilla|P|', 'Arnbjörnsson|Einar|E|']
D000293:Adolescent D001062:Appendectomy D001064:Appendicitis D002648:Child D002675:Child, Preschool D005260:Female D006801:Humans D015994:Incidence D007223:Infant D010535:Laparoscopy D008297:Male D061646:Operative Time D012189:Retrospective Studies D013525:Surgical Instruments D013530:Surgical Wound Infection
Appendectomy Children Appendicitis Acute abdomen Laparoscopy