{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:31:11Z","timestamp":1774971071098,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Surgical site infection (SSI) remains the most frequent postoperative complication after pediatric laparoscopic appendectomy. Evidence is scarce regarding whether the specimen extraction port site represents a modifiable risk factor. This study evaluated the association between 10 mm trocar placement for appendix extraction and postoperative outcomes in children undergoing laparoscopic appendectomy. Methods: A retrospective single-center cohort study was conducted including children aged 0\u201317 years who underwent laparoscopic appendectomy between January 2012 and January 2026 with \u226530-day follow-up. Patients were grouped by placement site of the 10 mm trocar: supraumbilical versus left lower quadrant (LLQ). The primary outcome was postoperative wound infection. Secondary outcomes included overall complications, intra-abdominal abscess, postoperative ileus, stump dehiscence, operative time, length of stay, readmission, reoperation, and conversion to laparotomy. Subgroup analyses assessed the impact of endoscopic retrieval-bag use within each trocar-position group. Results: Baseline demographic, clinical, laboratory, and histopathological characteristics were comparable between the two 10 mm trocar placement sites. Overall, postoperative complications were higher with supraumbilical placement than with LLQ placement (6.9% vs. 2.9%, p &lt; 0.001). SSI was more frequent with supraumbilical placement (3.7% vs. 0.3%, p &lt; 0.001). Multivariable analysis confirmed trocar position as an independent predictor of SSI, with LLQ placement associated with a lower risk (OR 0.52, 95% CI 0.30\u20130.88, p = 0.015). Operative time was shorter with LLQ placement (median 32 vs. 36 min, p &lt; 0.001). No significant differences were observed between placement sites in intra-abdominal abscess, postoperative ileus, readmission, reoperation, conversion to laparotomy, or length of hospital stay. Retrieval-bag use was not associated with differences in complication rates within either trocar placement site. Conclusions: LLQ 10 mm trocar placement site was associated with substantially lower SSI rates and shorter operative time compared with supraumbilical extraction, without increasing other postoperative complications. Extraction port selection may represent a simple technical measure to improve outcomes in pediatric laparoscopic appendectomy without requiring additional resources.<\/jats:p>","DOI":"10.3390\/medsci14020173","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T13:23:17Z","timestamp":1774963397000},"page":"173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Trocar Position on Surgical Site Infection After Pediatric Laparoscopic Appendectomy: A 15-Year Single-Center Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1517-720X","authenticated-orcid":false,"given":"Zenon","family":"Pogoreli\u0107","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, University Hospital of Split, 21000 Split, Croatia"},{"name":"Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mateo","family":"Kraljevi\u0107","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6278-3756","authenticated-orcid":false,"given":"Ivan","family":"Lovrin\u010devi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Hospital of Split, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1715-0768","authenticated-orcid":false,"given":"Ivan","family":"Male\u0161","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia"},{"name":"Department of Surgery, University Hospital of Split, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref_1","first-page":"621","article-title":"Acute Abdominal Pain in Children: Evaluation and Management","volume":"110","author":"Buel","year":"2024","journal-title":"Am. Fam. Physician"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Pogorelic, Z., Jukic, M., Zuvela, T., Milunovic, K.P., Males, I., Lovrin\u010devi\u0107, I., and Kraljevi\u0107, J. (2025). Salivary Biomarkers in Pediatric Acute Appendicitis: Current Evidence and Future Directions. Children, 12.","DOI":"10.3390\/children12101342"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1001\/jamasurg.2017.2221","article-title":"Association of Same-Day Discharge with Hospital Readmission After Appendectomy in Pediatric Patients","volume":"152","author":"Cairo","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jukic, M., Tesch, A., Todoric, J., Susnjar, T., Milunovic, K.P., Bari\u0107, T., and Pogoreli\u0107, Z. (2022). Same-Day Discharge after Laparoscopic Appendectomy for Simple Appendicitis in Pediatric Patients-Is It Possible?. Children, 9.","DOI":"10.3390\/children9081220"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1001\/jamasurg.2025.6218","article-title":"Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines","volume":"161","author":"Podda","year":"2026","journal-title":"JAMA Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.surg.2018.12.019","article-title":"The contemporary appendectomy for acute uncomplicated appendicitis in children","volume":"165","author":"Childers","year":"2019","journal-title":"Surgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1007\/s11605-020-04544-3","article-title":"Laparoscopic Versus Open Appendectomy for Acute Appendicitis in Children: A Nationwide Retrospective Study on Postoperative Outcomes","volume":"25","author":"Fujishiro","year":"2021","journal-title":"J. Gastrointest. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s00383-021-04911-4","article-title":"Surgical site infection after open and laparoscopic surgery in children: A systematic review and meta-analysis","volume":"37","author":"Alganabi","year":"2021","journal-title":"Pediatr. Surg. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.jpedsurg.2021.07.005","article-title":"Laparoscopic versus open appendicectomy for complicated appendicitis in children: A systematic review and meta-analysis","volume":"57","author":"Neogi","year":"2022","journal-title":"J. Pediatr. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6321","DOI":"10.1038\/s41598-024-79939-2","article-title":"Surgical site infection following appendectomy in children","volume":"15","author":"Azmeraw","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"466\u2013471","DOI":"10.1097\/SLA.0000000000000874","article-title":"Disease severity, not operative approach, drives organ space infection after pediatric appendectomy","volume":"260","author":"Kelly","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14793","DOI":"10.1038\/s41598-019-51172-2","article-title":"Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy\u2014Results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study","volume":"9","author":"Waledziak","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/j.surg.2018.11.012","article-title":"Does retrieval bag use during laparoscopic appendectomy reduce postoperative infection?","volume":"165","author":"Fields","year":"2019","journal-title":"Surgery"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pogorelic, Z., Mihanovic, J., Nincevic, S., Luksic, B., Elezovic Baloevic, S., and Polasek, O. (2021). Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children. Children, 8.","DOI":"10.3390\/children8040309"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s00423-021-02389-1","article-title":"A new approach to laparoscopic appendectomy in children-clipless\/sutureless Harmonic scalpel laparoscopic appendectomy","volume":"407","author":"Pogorelic","year":"2022","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pogorelic, Z., Odeverp, A., and Jukic, M. (2025). The Safety and Feasibility of Single-Stage Versus Staged Laparoscopic Approach for Acute Appendicitis with Inguinal Hernia in Pediatric Patients: A Comparative Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14124243"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1001\/jama.2022.24075","article-title":"Surgical Site Infection Prevention: A Review","volume":"329","author":"Seidelman","year":"2023","journal-title":"J. Am. Med. Assoc."},{"key":"ref_18","first-page":"857","article-title":"The Burden of Health Care Utilization, Cost, and Mortality Associated with Select Surgical Site Infections","volume":"50","author":"Shambhu","year":"2024","journal-title":"Jt. Comm. J. Qual. Patient Saf."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1089\/lap.2011.0492","article-title":"Open versus laparoscopic appendectomy in the pediatric population: A literature review and analysis of complications","volume":"22","author":"Esposito","year":"2012","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1007\/s00268-017-4123-3","article-title":"Systematic Review and Meta-Analysis of Laparoscopic Versus Open Appendicectomy in Adults with Complicated Appendicitis: An Update of the Literature","volume":"41","author":"Athanasiou","year":"2017","journal-title":"World J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.jpedsurg.2017.05.005","article-title":"Timing of antimicrobial prophylaxis and infectious complications in pediatric patients undergoing appendectomy","volume":"53","author":"Litz","year":"2018","journal-title":"J. Pediatr. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e034266","DOI":"10.1136\/bmjopen-2019-034266","article-title":"Global incidence of surgical site infection after appendectomy: A systematic review and meta-analysis","volume":"10","author":"Danwang","year":"2020","journal-title":"BMJ Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e15578","DOI":"10.1016\/j.heliyon.2023.e15578","article-title":"The effect of antibiotic prophylaxis on the incidence of surgical site infection after laparoscopic appendectomy for chronic appendicitis","volume":"9","author":"Dai","year":"2023","journal-title":"Heliyon"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.surg.2019.02.010","article-title":"Utilization of a specimen retrieval bag during laparoscopic appendectomy for both uncomplicated and complicated appendicitis is not associated with a decrease in postoperative surgical site infection rates","volume":"165","author":"Turner","year":"2019","journal-title":"Surgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1097\/SLE.0000000000001214","article-title":"Trocar Site Location in Laparoscopic Appendectomy-A Prospective Randomized Study","volume":"33","author":"Gundogan","year":"2023","journal-title":"Surg. Laparosc. Endosc. Percutan Tech."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ijsu.2016.09.087","article-title":"Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: A systematic review and meta-analysis","volume":"35","author":"Aly","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Kohler, F., Reese, L., Kastner, C., Hendricks, A., Muller, S., Lock, J.F., Germer, C.-T., and Wiegering, A. (2022). Surgical Site Infection Following Single-Port Appendectomy: A Systematic Review of the Literature and Meta-Analysis. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.919744"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1089\/lap.2016.0406","article-title":"Single-Incision Versus Three-Port Laparoscopic Appendectomy: Short- and Long-Term Outcomes","volume":"27","author":"Vellei","year":"2017","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4604","DOI":"10.1177\/00031348221124320","article-title":"Effect of Plastic Bag Extraction in Minimally Invasive Appendectomy","volume":"89","author":"Cauley","year":"2023","journal-title":"Am. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.sopen.2021.08.001","article-title":"Evidence-based surgery for laparoscopic appendectomy: A stepwise systematic review","volume":"6","author":"Bessoff","year":"2021","journal-title":"Surg. Open Sci."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Leandri, M., Vallicelli, C., Santandrea, G., Perrina, D., Bravi, F., Sartelli, M., Coccolini, F., Ansaloni, L., Agnoletti, V., and Catena, F. (2025). Postoperative infections after appendectomy for acute appendicitis: The surgeon\u2019s checklist. Antibiotics, 14.","DOI":"10.3390\/antibiotics14090954"},{"key":"ref_32","first-page":"203","article-title":"Is it necessary to use specimen retrieval bag for reducing surgical site infection in laparoscopic appendectomy? A randomized controlled trial","volume":"29","author":"Bostan","year":"2023","journal-title":"Turk. J. Trauma Emerg. Surg."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/173\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T13:47:04Z","timestamp":1774964824000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medsci14020173"],"URL":"https:\/\/doi.org\/10.3390\/medsci14020173","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}