Can Single Incision Laparoscopic Surgery be Considered Primarily for Patients with Complicated Appendicitis?

of the technical difficulties [7]. Attention is now focusing on how far it will develop and on how much its area of application will widen. Considering the refinement of indications for SILS, this study may be valuable because the authors focused on the feasibility and the benefits of SILS for “complicated” appendicitis. They reported better cosmetic result and similar postoperative complication rates of SILS for complicated appendicitis than of a conventional laparoscopic appendectomy. As far as we are currently aware, the main benefit to the patients undergoing SILS is superior cosmesis, but the questions remain as to whether a smaller or lesser incision correlates to a better clinical outcome. Unfortunately, this study obviously suffers from being a retrospective study. The sample size in each group is small, making it difficult to ascertain the differences in clinical parameters between the groups. To answer the question of whether the SILS appendectomy is technically feasible and safe in patients with complicated appendicitis, a larger number of patients is needed. Additional trocars were placed in 40 percent of the cases in this study, higher than in other reports [3, 6]. Since the expected benefit compared with conventional laparoscopy is likely to be small, a low threshold for using an additional port or for converting to conventional laparoscopic surgery may be essential. Multicenter, prospective, randomized trials are necessary to verify the safety, efficacy and feasibility of SILS for complicated appendicitis.