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Single Incision Pediatric Endoscopic Surgery with a Glove Access Technique vs Multiport Laparoscopic Appendectomy in Children: A Retrospective Study
*Maria Carmen Mora1, *Kyle Douglas1, *Kaitlyn E Wong1, *Jennifer Friderici1, *Gregory T Banever2, Kevin P Moriarty2, David B Tashjian2, Michael V Tirabassi2
1Baystate Medical Center, Springfield, MA;2Baystate Children's Hospital, Tufts University School of Medicine, Springfield, MA

OBJECTIVE
The purpose of this study was to compare outcomes and cost between single incision pediatric endoscopic surgery with a glove access technique (SIPES) and standard multiport laparoscopic appendectomy (SMPL).
DESIGN:
Retrospective Chart Review
SETTING:
non applicable
PATIENTS:
18 years of age and younger who underwent a laparoscopic appendectomy between July 2012 and December2013.
MAIN OUTCOME MEASURES
Patient demographics including age, gender, BMI, and race were extracted. Postoperative diagnosis, total operative time, total procedure time, PACU length of stay (LOS), total LOS, and costs were evaluated. In order to assess for pain levels, the average PACU pain score and average first 24-hour pain score were determined. Outcomes such as intra-abdominal abscess rate, wound infection, and bowel obstruction were compared.
RESULTS
A total of 251 patients were evaluated of which 81 (32.3%) were in the SIPES group. Age, race, gender, and cases of ruptured appendicitis were comparable between groups (p>0.40 all comparisons). There was no significant difference in the total procedure time (SIPES 59min vs. SMPL 55min, p=0.14) between groups. Average PACU pain score was significantly less in the SIPES group (1.8 vs. 2.7, p=0.005); however, average post-operative scores were similar (p=0.72). No significant difference was noted in total hospital cost; however, procedure cost was significantly lower with SIPES ($1526 vs. $3196, p<0.001). LOS and post-operative complications between groups were similar.
CONCLUSION
SIPES with glove access is a feasible and safe approach for the management of appendicitis in children. We observed significantly lower procedure cost for the SIPES approach compared to the SMPL, and found no significant difference in total procedure time, total hospital cost, and postoperative complication rates.


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