Clinical Report: Pediatric Appendectomy Using a Modified Two-Port Technique

Overview

This study evaluates a modified two-port laparoscopic appendectomy technique using absorbable clips and single-instrument knotting in pediatric patients. Compared to the Hem-o-lok clip method, this approach resulted in fewer postoperative complications despite a longer operative duration.

Background

Laparoscopic appendectomy is the gold standard for treating acute appendicitis in children, with ongoing efforts to minimize surgical trauma and improve cosmetic outcomes. The development of refined techniques, such as two-port laparoscopic methods, aims to reduce incision size while maintaining safety and efficacy. Understanding the comparative effectiveness of these techniques is crucial for optimizing pediatric surgical care.

Data Highlights

Key Findings

• The study included 133 pediatric patients, with 70 in the absorbable-clip cohort and 63 in the Hem-o-lok cohort.
• No significant differences in abdominal drain placement or postoperative length of stay were observed between the two groups (P > 0.05).
• The Hem-o-lok group had a significantly shorter operative duration (P < 0.05).
• Higher rates of subacute intestinal obstruction and postoperative abdominal pain were noted in the Hem-o-lok cohort (P < 0.05).
• Ultrasonographic evaluations indicated a more pronounced inflammatory response in the Hem-o-lok group.

Clinical Implications

The modified two-port laparoscopic appendectomy using absorbable clips may offer a safer alternative with fewer complications compared to the Hem-o-lok method. Surgeons should consider these findings when selecting techniques for pediatric appendectomy, particularly in terms of postoperative recovery and complication rates.

Conclusion

The findings suggest that while the modified two-port technique may take longer to perform, it is associated with fewer postoperative complications. Further validation through larger prospective studies is warranted.

Related Resources & Content

1. Surgical Endoscopy, 2025 -- Employing an Endoscopic Snare to Enhance Two-Port Laparoscopic Appendectomy Techniques
2. Frontiers in Pediatrics, 2026 -- Transumbilical laparoscopic-assisted appendectomy: a feasible minimally invasive option for pediatric acute appendicitis with comparable outcomes to three-port laparoscopic appendectomy
3. Comparison of Single and Double Hem-o-lok Clips for Securing the Appendiceal Stump in Laparoscopic Appendectomy: A Prospective Randomized Multicenter Study
4. Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines | Emergency Medicine | JAMA Surgery | JAMA Network
5. Closure of Appendix Stump Using Titanium Clips During Laparoscopic Appendectomy
6. Comparison of transumbilical laparoscopic-assisted appendectomy (TULAA) vs conventional three-port laparoscopic appendectomy (CTLA) in the pediatric population: a systematic review and meta-analysis
7. Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines | Emergency Medicine | JAMA Surgery | JAMA Network