Abstract:Objective To analyze and compare the clinical efficacy of transumbilical single-port laparoscopic appendectomy (SPLA) and conventional three - port laparoscopic appendectomy (CLA) in the treatment of acute appendicitis, and to compare postoperative incisional pain, cosmetic outcome, and complications between the two approaches. Methods A retrospective analysis was conducted on 596 patients who underwent laparoscopic appendectomy at the Department of Gastrointestinal Surgery, Wuhan Puren Hospital, from January 2019 to September 2023. Patients were divided into the SPLA group (n=141) and the CLA group (n=455) based on the surgical approach. Baseline characteristics, operative time, intraoperative blood loss, hospital stay, hospitalization costs, recovery time of gastrointestinal function, cosmetic outcome [Vancouver Scar Scale (VSS) score], incisional pain [Visual Analog Scale (VAS) score], frequency of analgesic use, inflammatory markers [interleukin-6 (IL-6)] on 3rd day after surgery, and postoperative complications were compared between the two groups. Results No significant difference was observed in intraoperative blood loss and IL-6 levels on 3rd day after surgery between the two groups ( P> 0.05). Compared with the CLA group, the SPLA group had a shorter hospital stay [ ( 3.83±1.56) days vs (4.63±1.27) days, t= 5.546, P＜0.01], lower hospitalization costs [ ( 1.39±0.33) ten thousand yuan vs (1.73±0.32) ten thousand yuan, t= 10.704, P= 0.003], earlier recovery of gastrointestinal function [ ( 18.26±3.93) h vs (20.40±4.53) h, t= 5.057, P＜0.001], lower VSS score (4.65±2.09 vs 5.02±1.85, t= 2.011, P= 0.045), lower VAS score (3.87±1.21 vs 5.03±1.29, t= 9.465, P＜0.01), and less frequent use of analgesics (P＜0.05). However, operative time was longer in the SPLA group [ (51.23±10.77) min vs (43.72 ± 7.13) min, t= 7.769, P＜0.05]. There was no significant difference in the incidence of postoperative incision infection between the two groups (χ²=0.250, P= 0.619). During a 3-month follow-up, no complications such as bleeding, intra-abdominal abscess, ileus, incisional hernia, appendiceal stump inflammation, or intestinal fistula occurred in either group. Conclusion Both SPLA and CLA demonstrate good efficacy and safety. However, compared with CLA, SPLA offers advantages including reduced postoperative pain, earlier ambulation, quicker gastrointestinal recovery, shorter hospital stays, lower costs, and improved cosmetic outcome.