Modified single-site two-port laparoscopic appendectomy with single-instrument knotting and absorbable clips in children: a retrospective study.

OBJECTIVE

To evaluate the clinical efficacy of a modified single-site two-port laparoscopic suspension technique combined with single-instrument knotting and absorbable clips in pediatric appendectomy, and to compare it with the single-site Hem-o-lok clip technique.

METHODS

This retrospective study reviewed pediatric patients with acute appendicitis treated at our institution between January 2024 and March 2025. Patients who underwent one of the two single-site two-port laparoscopic techniques were included and classified according to the closure method used for the appendiceal stump and mesoappendix: absorbable clips combined with single-instrument knotting or Hem-o-lok clips. Perioperative outcomes, postoperative complications, ultrasonographic findings, and postoperative inflammatory markers were evaluated.

RESULTS

A total of 133 pediatric patients were included, with 70 in the absorbable-clip group and 63 in the Hem-o-lok group. No significant differences were found between the two groups in abdominal drain placement, time to drain removal, intraoperative blood loss, time to first postoperative flatus, or postoperative hospital stay (P > 0.05). Operative time was significantly shorter in the Hem-o-lok group (P < 0.05). The incidences of subacute intestinal obstruction and postoperative abdominal pain were significantly higher in the Hem-o-lok group (P < 0.05), whereas incision infection, stump inflammation, and fecal leakage did not differ significantly between groups (P > 0.05). Ultrasonographic follow-up and postoperative inflammatory markers showed a stronger and more sustained inflammatory response in the Hem-o-lok group during follow-up. Two patients in the Hem-o-lok group required reoperation for clip removal because of refractory symptoms.

CONCLUSION

Although the modified single-site two-port laparoscopic suspension appendectomy combined with single-instrument knotting and absorbable clips required a slightly longer operative time than the Hem-o-lok clip technique, it was associated with fewer postoperative complications and a milder postoperative inflammatory response. These findings should be interpreted cautiously and confirmed in larger prospective studies with longer follow-up.