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Int J Surg. 2016 Nov;35:120-128. doi: 10.1016/j.ijsu.2016.09.087. Epub 2016 Oct 2.

Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: A systematic review and meta-analysis.

Author information

1
Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom. Electronic address: oaly@nhs.net.
2
Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom.

Abstract

BACKGROUND:

Appendicectomy is a well-established surgical procedure used in the management of acute appendicitis. The operation can be performed with minimally invasive surgery or as an open procedure. A further development in the minimally invasive appendicectomy technique has been the introduction of single incision laparoscopic surgery (SILA).

AIM:

To ascertain any differences in outcomes from available trials comparing SILA with conventional multi-incision laparoscopic appendicectomy (CLA).

METHODS:

A literature search of MEDLINE/PubMed, EMBASE/Ovid and CENTRAL for articles from Jan1990 to June 2015 with key words: 'appendectomy', 'appendicetomy'; 'appendicitis'; 'laparoscopy'; 'keyhole'; 'single port'; 'single incision'; 'single site'; 'one port'; 'incisionless'; 'scarless'. Randomised control trials of patients with signs and symptoms of appendicitis undergoing laparoscopic appendicectomy, with one arm being SILA were included. Statistical analysis was performed through Mantle-Haenszel and inverse variance methods.

RESULTS:

A total of 8 RCTs published between 2012 and 2014 with a total of 995 patients were included. Meta-analysis showed no significant differences between SILA and CLA for complication rates, post-operative ileus, length of hospital stay, return to work or post-operative pain. CLA was significantly superior to SILA with reduced operating time (mean difference 5.81 [2.01, 9.62] P = 0.003) and conversion rates (OR 4.14 [1.93, 8.91] P = 0.0003). SILA surgery had better wound cosmesis (mean difference 0.55 [0.33, 0.77] P = 0.00001).

CONCLUSION:

SILA is comparable to CLA in terms of complications, post-operative pain and recovery. Therefore, SILA could be a viable option in the hands of an experienced surgeons and for patients' groups who place great value on the final cosmetic outcome.

KEYWORDS:

Acute appendicitis; Laparoscopic; Single incision laparoscopic surgery

PMID:
27686264
DOI:
10.1016/j.ijsu.2016.09.087
[Indexed for MEDLINE]
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