Impact of Trocar Position on Surgical Site Infection After Pediatric Laparoscopic Appendectomy: A 15-Year Single-Center Study.

Background

Surgical site infection (SSI) remains the most frequent postoperative complication after pediatric laparoscopic appendectomy. Evidence is scarce regarding whether the specimen extraction port site represents a modifiable risk factor. This study evaluated the association between 10 mm trocar placement for appendix extraction and postoperative outcomes in children undergoing laparoscopic appendectomy.

Methods

A retrospective single-center cohort study was conducted including children aged 0-17 years who underwent laparoscopic appendectomy between January 2012 and January 2026 with ≥30-day follow-up. Patients were grouped by placement site of the 10 mm trocar: supraumbilical versus left lower quadrant (LLQ). The primary outcome was postoperative wound infection. Secondary outcomes included overall complications, intra-abdominal abscess, postoperative ileus, stump dehiscence, operative time, length of stay, readmission, reoperation, and conversion to laparotomy. Subgroup analyses assessed the impact of endoscopic retrieval-bag use within each trocar-position group.

Results

Baseline demographic, clinical, laboratory, and histopathological characteristics were comparable between the two 10 mm trocar placement sites. Overall, postoperative complications were higher with supraumbilical placement than with LLQ placement (6.9% vs. 2.9%, p < 0.001). SSI was more frequent with supraumbilical placement (3.7% vs. 0.3%, p < 0.001). Multivariable analysis confirmed trocar position as an independent predictor of SSI, with LLQ placement associated with a lower risk (OR 0.52, 95% CI 0.30-0.88, p = 0.015). Operative time was shorter with LLQ placement (median 32 vs. 36 min, p < 0.001). No significant differences were observed between placement sites in intra-abdominal abscess, postoperative ileus, readmission, reoperation, conversion to laparotomy, or length of hospital stay. Retrieval-bag use was not associated with differences in complication rates within either trocar placement site.

Conclusions

LLQ 10 mm trocar placement site was associated with substantially lower SSI rates and shorter operative time compared with supraumbilical extraction, without increasing other postoperative complications. Extraction port selection may represent a simple technical measure to improve outcomes in pediatric laparoscopic appendectomy without requiring additional resources.