title: Acute appendicitis can be treated with single-incision laparoscopy: a systematic review of randomized controlled trials.
abstract: OBJECTIVE
  Single-incision laparoscopic surgery (SILS) has been proposed as the next step in minimally invasive surgery for appendicectomy. Previous reviews have summarized the results of low-evidence comparative studies, suggesting that the two approaches are comparable in terms of outcomes but showing the need for randomized controlled trials (RCTs). This review offers a meta-analyses of RCTs on this topic to evaluate the safety and efficacy of single-incision laparoscopic appendectomy (SILA).
  
  
  METHODS
  A comprehensive research of electronic databases was performed. Primary outcomes (overall and access-specific morbidity) were designated as safety issues. Secondary outcomes were pain, cosmesis, operative time, conversion rate and length of hospital stay.
  
  
  RESULTS
  After exclusions, five RCTs satisfied the inclusion criteria. They included a total of 761 patients [379 SILA and 382 conventional three-port laparoscopic appendectomies (CLA)]. No significant differences were found in overall morbidity, early wound morbidity or length of stay between SILA and CLA. Cosmesis and pain were not comparable due to different scales and time records. Conclusions on the incisional hernia rate were not reliable due to short follow-up periods.
  
  
  CONCLUSIONS
  SILA can be considered an acceptable alternative to CLA in the treatment of acute appendicitis, but an economic evaluation of the various techniques for single access must be performed before its widespread clinical introduction. Better-designed RCTs are necessary to define a population in which SILA could have major benefits.
authors.affiliation: Laparoscopic Surgical Unit, M. Mellini Hospital, Chiari (BS), Italy.
authors.forename: N
authors.initials: N
authors.lastname: Vettoretto
authors.forename: R
authors.initials: R
authors.lastname: Cirocchi
authors.forename: J
authors.initials: J
authors.lastname: Randolph
authors.forename: M
authors.initials: M
authors.lastname: Morino
mesh_terms: D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data*; D061646:Operative Time; D010149:Postoperative Pain; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Appendicitis; laparoscopy; single site surgery