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Introduction:Laparoendoscopic single-site(LESS) surgery for appendectomy has not been shown to have any clear clinical benefit compared to traditional multiport laparoscopic appendectomy. Likewise, studies indicate that multiport laparoscopic appendectomy and open appendectomy have equivalent outcomes. In this study, we directly compare the outcomes of open and LESS surgery for appendectomy in uncomplicated cases of acute appendicitis. Methods:We reviewed outcomes of all LESS and open appendectomies for acute appendicitis at a single institution between January and December of 2008. Exclusion criteria included the following: perforated appendicitis documented on preoperative radiography or at the time of surgery, and pathology findings inconsistent with acute appendicitis. A total of 66 patients underwent open surgery, 211 patients underwent multiport laparoscopic surgery, and 9 patients underwent LESS surgery. Data was collected on postoperative narcotic consumption, postoperative hospital length of stay (LOS), and readmissions related to the original procedure. Statistical significance was defined as p <0.05. Results:Patients ranged in age from 24 to 52 years (mean = 34 years) in the LESS group and 18 to 70 years (mean = 18 years) in the open surgery group. The mean dose of intravenous narcotics consumed postoperatively was 2.0 mg of morphine (SD = 2.8) in the LESS surgery group, and 3.4 mg (SD = 7.4) in the open surgery group (p = 0.58). The mean amount of oral narcotics (Percocet, Vicodin, or Tylenol #3) consumed postoperatively was 4.4 tablets (SD = 3.6 tablets) in the LESS surgery group and 3.9 tablets (SD = 3.3) in the open surgery group (p = 0.62). Postoperative LOS was 36.1 hours (SD= 16.6 hours) in the LESS surgery group and 33.9 hours (SD=26.3 hours) in the open surgery group (p= 0.81). 3 patients required readmission in the open surgery group; one patient developed a wound infection requiring intravenous antibiotics, one patient developed an intraabdominal abscess requiring percutaneous drainage, and one patient developed fascial dehiscence secondary to a broken suture requiring reoperation. No patients required readmission in the LESS surgery group (Z=-0.253, p=0.80). Discussion:While LESS appendectomy for acute appendicitis has been demonstrated to be safe and feasible in select patients, this study shows equivalent outcomes of both approaches in regards to postoperative narcotic consumption, postoperative LOS, and postoperative readmissions for procedure-related complications. While more patients who underwent open surgery were readmitted postoperatively, our modest sample size may have prohibited detection of statistical significance. Further investigation with a larger sample size is necessary to clarify the short-term and long-term outcomes of LESS appendectomy compared to open appendectomy.
Postoperative variables

	LESS group	Open group	p-value
Intravenous narcotics (mg morphine)	2.0 (SD=2.8)	3.4 (SD=7.4)	0.58
Oral narcotics (# tabs)	4.4 (SD=3.6)	3.9 (SD=3.3)	0.62
Postoperative LOS (hours)	36.1 (SD=16.6)	33.9 (SD=26.3)	0.81