A comparative study of Single Incision Laparoscopic Appendectomy (SILA) using gloves port vs Conventional Laparoscopic Appendectomy (CLA) in the management of Appendicitis

Abstract

Background: Single-incision laparoscopic appendectomy (SILA) has emerged as an alternative to conventional laparoscopic appendectomy (CLA), with potential cosmetic advantages. A handmade glove port offers a low-cost method of performing single-incision surgery. Aim: To compare the feasibility, safety, operative characteristics, postoperative outcomes, and cosmetic results of SILA using a glove port with CLA in patients undergoing appendectomy. Materials and Methods: This prospective randomized comparative study was conducted in the Department of General Surgery, Silchar Medical College and Hospital, Silchar, Assam, from June 2019 to May 2021. A total of 46 patients with acute or recurrent appendicitis were included. Thirty patients were allocated to SILA and 16 to CLA. Operative duration, technical difficulty, conversion, postoperative pain using VAS, analgesic requirement, complications, hospital stay, return to normal activity, and cosmetic outcome using POSAS (Patient and Observer Scar Assessment Scale) were evaluated. Results: SILA was successfully completed in 25 of 30 patients, while five required an additional port. Mean operative duration was significantly longer with SILA than CLA (64.20 ± 27.73 vs 36.38 ± 8.33 minutes; p=0.000383). Median technical difficulty score was also higher with SILA (7 vs 4; p=0.0008). Median VAS scores at 6, 18, and 36 hours were significantly higher in SILA, with greater analgesic requirement (4.68 ± 1.40 vs 3.06 ± 0.68 doses; p=0.000118). Hospital stay was longer in the SILA group (3.28 ± 1.17 vs 2.31 ± 0.47 days; p=0.003353). Patient-reported scar assessment favoured SILA (median PSAS 7 vs 8; p=0.007), whereas OSAS (Observer Scar Assessment Scale) was comparable. Adhesions were strongly associated with conversion, with five of seven SILA patients with peri-appendiceal adhesions requiring an additional port. Conclusion: Glove-port SILA was feasible and provided better patient-reported cosmetic satisfaction but was technically more demanding and associated with longer operative time, greater early postoperative pain, and longer hospital stay. Careful patient selection, particularly avoidance of cases with significant peri-appendiceal adhesions, may improve outcomes. Keywords: Appendicitis; single-incision laparoscopic appendectomy; glove port; conventional laparoscopic appendectomy; postoperative pain; cosmesis.