Trocar placement via the suprapubic approach makes access to and dissection of the kinase inhibitor Volasertib appendix easy, and it also enables exteriorization of a drain without adding new lateral incisions [17]. When the diagnosis was established, we found the appendix oedematous, gangrenous, perforated with varying degree of peritonitis, or even associated with peritoneal abscess. According to our short limited experience, we think SPAA technique seems to be suitable for the variety of appendicitis. Because of the initial experience and the cosmetic research, SPAA has been performed in nonobese and obese patients. According to the literature especially obese patients benefit from LA compared to open one [6, 18]. Unfortunately, at the time of the randomization, the BMI was not calculated but retrospectively analysed, the BMI of the SPAAG is not different from LAG.

This is probably because of the lack of experience in the first cases, the fear of umbilical closure, and the search of a better cosmetic result in young women. Many of our patients were adolescent females who may be very aware of their body image. It seems reasonable to think that the benefits of transition from standard laparoscopic approach to SPAA will be easier than the transition from open to laparoscopic appendectomy. Accordingly, we believe that the use of this approach for appendectomy is worthwhile. SPAA can be performed properly by one straight instrument and one curved instrument, and even by two standard straight instruments, making the procedure easier compared to use of two curved instruments.

New devices and new technology is now available at the time of writing that makes this technique easier. Concerning the cosmetic result, at the end of the procedure, surgeons took time performing a careful reconstruction of the umbilicus in both groups. Cosmetic results show that there is a certain advantage of performing the single-incision surgery compared to standard one. Patients seem to be more satisfied with the overall result and with the cosmetic result. However, this is a difficult subjective opinion and difficult to measure. According to other authors, the issue of the influence of abdominal scar on the cosmetic and body image showed no difference between open and traditional laparoscopic appendectomies [19]. Our patients are more satisfied with the SPAA than LA (P < 0,05), but the importance of abdominal scar may be age and sex related.

There is a feeling that young nurses would have Anacetrapib scarless operation rather than LA or even open approach. Some authors suggest that suprapubic SILS appendectomy offers better, cosmetically appealing results than the standard umbilical access [17]. However, the data generated by the use of our questionnaire is of dubious quality and cannot be used to make any meaningful statements on satisfaction and cosmetics because it has not been validated.