Transumbilical three-port vs conventional laparoscopic appendectomy: A single-center retrospective comparative study

Vollständiger Abstract

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BACKGROUND Laparoscopic appendectomy (LA) is a widely accepted treatment for acute appendicitis. Conventional three-port techniques require additional abdominal incisions that may affect cosmetic outcomes, whereas transumbilical approaches may improve scar concealment. However, direct comparative evidence remains limited. AIM To evaluate the safety and perioperative outcomes of transumbilical three-port LA compared with conventional LA. METHODS This retrospective single-center comparative study included 77 patients who underwent LA between June 2022 and October 2023 at a tertiary hospital. Patients were treated with either a transumbilical three-port approach (n = 51) or conventional LA (n = 26). Baseline characteristics, operative outcomes, postoperative pain scores, complications, hospitalization costs, and cosmetic outcomes were compared. Logistic regression analysis was performed to identify predictors of prolonged hospitalization (> 3 days). RESULTS All procedures were completed laparoscopically without conversion or major complications. Operative time, postoperative complications, and early pain scores were comparable between groups (all P > 0.05), with a trend toward lower pain in the cosmetic group. Total hospitalization costs were higher in the cosmetic group (P < 0.05), which may partly reflect temporal variations in consumable and medication pricing. In univariate analysis, elevated preoperative white blood cell (WBC) count and C-reactive protein levels were associated with prolonged hospitalization (P < 0.05). After adjustment, preoperative WBC remained the only independent predictor (adjusted odds ratio = 11.55, 95% confidence interval: 2.28-80.44). CONCLUSION Transumbilical three-port LA using conventional instruments appears safe and feasible and may improve cosmetic outcomes without increasing operative risk or hospital stay. Preoperative WBC may predict hospitalization duration.