Systematic review and meta-analysis of single-incision versus conventional multiport appendicectomy.
BACKGROUND
The aim of this systematic review and meta-analysis was to compare clinical outcomes following single-incision laparoscopic appendicectomy (SILA) and conventional multiport laparoscopic appendicectomy (CLA) for the treatment of acute appendicitis.


METHODS
An electronic search of MEDLINE, Embase, Web of Science and Cochrane Library databases was performed. Publications were included if they were clinical trials randomizing patients with appendicitis to SILA or CLA. Outcome measures evaluated included operating time, length of hospital stay, total postoperative complications, and, specifically, wound infection, intra-abdominal collection and ileus. Weighted mean difference was calculated for the effect size of SILA on continuous variables, and pooled odds ratios were calculated for discrete variables.


RESULTS
The literature search identified seven randomized clinical trials that met the inclusion criteria for meta-analysis. In total, 1108 appendicectomies were included, 555 SILA and 553 CLA procedures. There were no significant differences between the groups in the incidence of total postoperative complications, wound infection, intra-abdominal collection, ileus or length of hospital stay. However, SILA was associated with a significantly longer operating time compared with CLA (weighted mean difference 6·96 (95 per cent confidence interval 3·79 to 10·12) min; P < 0·001). Insertion of an additional port was required in 7·6 per cent of patients undergoing SILA.


CONCLUSIONS
SILA is a safe procedure for the treatment of acute appendicitis, with comparable clinical outcome to CLA when undertaken by experienced laparoscopic surgeons.
Department of Laparoscopic and Upper Gastro-Intestinal Surgery, Hinchingbrooke Healthcare NHS Trust, Huntingdon.
S R
SR
Markar
A
A
Karthikesalingam
F
F
Di Franco
A M
AM
Harris
D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology; D059413:Intraabdominal Infections / Q000209:etiology; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult