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Single Incision Laparoscopic Appendectomy--Is Obesity A Contraindication?

Saturday, October 20, 2012: 1:20 PM
Napoleon Ballroom (Hilton Riverside)
Govardhana Yannam, MD1, Mike K. Chen, MD1, Scott A. Anderson, MD1, Russell L. Griffin, PhD2, Elizabeth A. Beierle, M.D.1 and Carroll M. Harmon, MD, PhD1, (1)Pediatric Surgery, The Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL, (2)Epidemiology; Center for Clinical Translational Science, University of Alabama at Birmingham, School of Public Health, Birmingham, AL

Purpose: Single-incision pediatric endosurgery (SIPES) has gained popularity and has been reported to be safe in acute (non-perforated) and perforated appendicitis. The feasibility of SIPES appendectomy in obese children is unknown.

Methods: After IRB approval, data were collected from a prospectively maintained SIPES appendectomy database for cases performed between April 2009 and March 2012. Patients were divided into obese and non-obese groups based on Center for Disease Control criteria for obesity in children, BMI ≥ 95th percentile. The surgical techniques, operative times, complications, conversion rates, and outcomes were recorded.

Results: SIPES appendectomy was attempted in 500 children. Overall, 37% were female, median age was 10.9±3.8 years (range 1.4-17.9); 353 (70.6%) had acute (non-perforated) appendicitis, 89 (17.8%) had perforated appendicitis, and 58 (11.6%) underwent interval appendectomy. There were 105 (21%) obese children. Mean operative time, blood loss, requirement of additional trocars and intraoperative complications in non-obese children (38.9±16.7 min; 3.7±7.4 ml; 18 required additional trocars; 3 intraoperative complications) and obese children (40.7±14.9 min; 4.8±6.1 ml; 2 patients required additional trocars; no intraoperative complications) were not significantly different. Mean hospital stay for both groups was similar (2.3 days). Post operative wound infections (3.3% vs. 4.8%, p=0.55, non-obese vs. obese) and intraabdominal abscesses (4.3% vs. 2.9%, p=0.77, non-obese vs. obese) were not significantly different. Patient age, indication for procedure (acute, perforated and interval appendectomy) or level of training (residents vs fellows) did not influence the outcome between groups.

Conclusion: SIPES appendectomy may be accomplished successfully and safely in obese children. Obesity does not appear to be associated with increased risk of complications and is not a contraindication for SIPES appendectomy.