Stepwise Approach to Laparoscopic Appendicectomy in Children

Anisha Sarkar, Joselito Tantoco, Chris Kimber, Yves Heloury, Peter Ferguson, Wei Cheng

Research output: Contribution to journalArticleResearchpeer-review


Traditionally, three ports are used in laparoscopic appendicectomy. However to reduce surgical incision and cost, it is feasible to remove the appendix using fewer ports. In this study, we compared the efficacy of stepwise and standard approach in laparoscopic appendicectomies in children. Between August 2008 and September 2010, 378 children with appendicitis were allotted to either the stepwise or standard laparoscopy group depending on the operating surgeon’s preference. In the former group, an operating telescope was inserted first. The number of ports used was based on the pathology (stepwise approach). In the latter group, three ports were inserted in all patients (standard approach). The two groups were similar. In the stepwise group, we performed 95 single port (utilising a scope with an instrument channel), 37 two ports and 13 three ports appendicectomies. In the stepwise group, operating time was shorter (not yet statistically significant) and it reduced the port numbers by more than 50 %. The stepwise approach provides an evidence-based management of appendicitis with comparable outcomes. This procedure further reduces incision trauma, operating times and the cost of operation. However, the reduction of post-operative analgesic requirement needs further study.

Original languageEnglish
Pages (from-to)243-246
Number of pages4
JournalIndian Journal of Plastic Surgery
Issue number3
Publication statusPublished - Jun 2014
Externally publishedYes


  • Appendicectomy
  • Children
  • Laparoscopy
  • Standard
  • Stepwise

Cite this

Sarkar, A., Tantoco, J., Kimber, C., Heloury, Y., Ferguson, P., & Cheng, W. (2014). Stepwise Approach to Laparoscopic Appendicectomy in Children. Indian Journal of Plastic Surgery, 76(3), 243-246.