The Modified Transumbilical Single Incision Laparoscopic Appendectomy Versus The Tranditional Open Appendectomy:a Clinical Comparative Analysis

Objectives To investigate the safety and therapeutic effect of the modified transumbilical single incision laparoscopic appendectomy through comparing with the Traditional open Appendectomy.Methods The databases of this retrospective analysis were obtained from 102 laparoscopic or open appendectomy cases conducted in the General Surgery Department of Guangdong Xinyi People’s Hospital from January 2012 to January 2015. Among all of those cases,50 ones received the modified transumbilical single incision laparoscopic appendectomy combined with fast track surgery (experimental group),52 ones were taken by traditional open surgery (control group). The changes of white blood cell count, C-reaction protein, PCT and IL-6 were detected in the first day before surgery and the number 1,3day after surgery. The seven comparison indexes includes average operative time, amount of bleeding, mean postoperative hospital stay, postoperative pain score of 6 hours, the digestive function recovery, the rate of postoperative complications, hospitalization expenses.Results All 102 operations were successfully conducted, and the experimental group received the modified transumbilical single incision laparoscopic appendectomy without conversion to open laparotomy. The levels of WBC, CRP, PCT and IL-6 at day 1 after surgery were significantly higher than those before surgery; then the value in experimental group increased slower than in control group. But at day 3 the levels of WBC, CRP, PCT and IL-6 in both groups was lower than the day 1; their degree in experimental group decreased faster than those in control group, showing significant difference between them. Comparing the modified transumbilical single incision laparoscopic appendectomy with fast track surgery to the traditional open Appendectomy, the average operative time of the former was (36.1±3.2) min and of the latter was (40.3±3.8)min; the amount of bleeding of the former was (5.2±0.8)ml and of the latter was (15.3±2.6)m; the mean postoperative hospital stay of the former was (2.2±0.8)d and of the latter was (5.3±0.5)d, the postoperative pain score in 6 hours of the former was (3.2±0.8) and of the latter was (6.8±1.2); the digestive function recovery of the former was (23.3±9)h and of the latter was (30.5±11)h; the rate of postoperative complications of the former was 0 and of the latter was 5, the total expenses of the former was (8322.82±683.27) yuan and of the latter was (7587.61±388.36) yuan. Except the average operative time and the total expenses, the other data of the experiment group have significant difference compared to the control group (P>0.05).Conclusion The modified transumbilical single incision laparoscopic appendectomy combined with fast track surgery is more close to the concept of minimally invasive with the assets of fewer scars and complication. It could be adapted to the patients with acute appendicitis, especially with acute simple appendicitis or acute suppurative appendicitis, for obviously shorter hospitalization and fast recovering.