Acta Biomedica Scientia

COMPARATIVE EVALUATION OF STEPWISE VERSUS CONVENTIONAL THREE-PORT LAPAROSCOPIC APPENDICECTOMY IN PEDIATRIC APPENDICITIS

Dr Abhiram Kumar C1*, Dr Saginala Ravichandra 2, Dr.M.Pallavi

Laparoscopic appendicectomy, Stepwise technique, Pediatric appendicitis, Minimally invasive surgery, Surgical outcomes.

Acute appendicitis is the most common cause of emergency intra-abdominal surgery in children. While the conventional laparoscopic appendicectomy typically involves three ports, modified techniques such as the stepwise approach aim to reduce invasiveness, improve cosmetic outcomes, and lower costs. Objective: This study compared clinical outcomes and complication rates between the stepwise laparoscopic appendicectomy technique and the conventional three-port method in pediatric patients. Methods: A prospective observational study was conducted including children diagnosed or suspected with appendicitis who underwent laparoscopic appendicectomy performed by 12 specialists. Patients were assigned to either a stepwise port placement technique, where ports were added based on intraoperative findings, or the standard three-port method. Demographic data, operative details, complication rates, and postoperative outcomes were collected and analyzed using descriptive statistics, Student’s t-test, and analysis of variance. Results: Among 700 patients (Stepwise, N=250; Standard, N=450), complication rates were comparable between groups (5.4% vs. 10.1%, p > 0.05). The mean operative time was shorter in the stepwise group (50.5 vs. 64.5 minutes), though not statistically significant. The number of ports used per patient was significantly lower in the stepwise group (1.38 vs. 2.95, p = 0.04), indicating a less invasive procedure. No significant differences were observed in perforation rates, negative appendicectomy rates, or length of hospital stay. Conclusions: Compared to the usual three-port approach, the stepwise laparoscopic appendicectomy is both safer and just as effective in children, with far fewer ports needed. Laparoscopy can lead to little surgical trauma, improved how the area appears after surgery and sometimes even reduces costs. More extensive randomized trials are necessary to confirm these findings and monitor long-term results that matter to patients