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World Journal of Surgery

, Volume 38, Issue 8, pp 1937–1946 | Cite as

Systematic Review and Meta-Analysis of Randomized Controlled Trials Comparing Single Incision versus Conventional Laparoscopic Appendectomy

  • Michael ClerveusEmail author
  • Antonio Morandeira-Rivas
  • Carlos Moreno-Sanz
  • Maria Luz Herrero-Bogajo
  • Joaquin Salvelio Picazo-Yeste
  • Gloria Tadeo-Ruiz
Article

Abstract

Background

Single incision laparoscopic appendectomy (SILA) has been proposed as an alternative to conventional laparoscopic appendectomy (CLA).

Objective

The aim of this study was to evaluate the safety and efficacy of SILA when compared with CLA through a systematic review.

Methods

We performed an electronic search of EMBASE, PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that compared SILA with CLA were included.

Results

Six RCTs met eligibility criteria, which included a total of 800 patients, 401 in the SILA group and 399 in the CLA group. There were no significant differences in terms of overall complications (odds ratio [OR] 0.93; 95 % confidence interval [CI] 0.59–1.47; p = 0.77). SILA had a higher technical failure rate (OR 3.30; 95 % CI 1.26–8.65; p = 0.01) and required a longer operative time (mean difference [MD] 4.67; 95 % CI 1.76–7.57; p = 0.002). SILA was associated with better cosmetic results (standardized MD –0.4; 95 % CI –0.64 to –0.16; p = 0.001) and earlier return to normal activity (MD –0.64; 95 % CI –1.09 to –0.20; p = 0.005), although these advantages should be taken with caution due to the small number of studies reporting these two items and the short follow-up in the evaluation of cosmetic results. There were no significant differences in terms of postoperative pain or length of hospital stay between groups.

Conclusions

SILA is comparable to CLA in selected patients, although it is associated with a higher technical failure rate and longer operative time. Further randomized trials are needed to determine if SILA really offers benefits over CLA.

Keywords

Postoperative Pain Appendicitis Incisional Hernia Acute Appendicitis Cosmetic Result 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

The authors have no conflicts of interest to declare.

References

  1. 1.
    Addiss DG, Shaffer N, Fowler BS et al (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925PubMedGoogle Scholar
  2. 2.
    Wilms IM, de-Hoog DE, de-Visser DC et al (2011) Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev 11:CD008359PubMedGoogle Scholar
  3. 3.
    Vettoretto N, Gobbi S, Corradi A et al (2011) Consensus conference on laparoscopic appendectomy: development of guidelines. Colorectal Dis 13:748–754PubMedCrossRefGoogle Scholar
  4. 4.
    Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 10:CD001546PubMedGoogle Scholar
  5. 5.
    Tiwari MM, Reynoso JF, Tsang AW et al (2011) Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 254:927–932PubMedCrossRefGoogle Scholar
  6. 6.
    Pelosi MA, Pelosi MA III (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594PubMedGoogle Scholar
  7. 7.
    Vidal O, Valentini M, Ginestà C et al (2010) Laparoendoscopic single-site surgery appendectomy. Surg Endosc 24:686–691PubMedCrossRefGoogle Scholar
  8. 8.
    Park J, Kwak H, Kim SG et al (2012) Single-port laparoscopic appendectomy: comparison with conventional laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A 22:142–145PubMedCrossRefGoogle Scholar
  9. 9.
    Raakow R, Jacob DA (2011) Initial experience in laparoscopic single-port appendectomy: a pilot study. Dig Surg 28:74–79PubMedCrossRefGoogle Scholar
  10. 10.
    Kim HO, Yoo CH, Lee SR et al (2012) Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery. J Korean Surg Soc 82:172–178PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Gill RS, Shi X, Al-Adra DP et al (2012) Single-incision appendectomy is comparable to conventional laparoscopic appendectomy: a systematic review and pooled analysis. Surg Laparosc Endosc Percutan Tech 22:319–327PubMedCrossRefGoogle Scholar
  12. 12.
    Pisanu A, Porceddu G, Reccia I et al (2013) Meta-analysis of studies comparing single-incision laparoscopic appendectomy and conventional multiport laparoscopic appendectomy. J Surg Res 183:e49–e59PubMedCrossRefGoogle Scholar
  13. 13.
    Rehman H, Mathews T, Ahmed I (2012) A review of minimally invasive single-port/incision laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A 22:641–646PubMedCrossRefGoogle Scholar
  14. 14.
    Moher D, Liberati A, Tetzlaff J et al (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341PubMedCrossRefGoogle Scholar
  15. 15.
    Higgins J, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. The Cochrane CollaborationGoogle Scholar
  16. 16.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Kang J, Bae BN, Gwak G et al (2013) Comparative study of a single-incision laparoscopic and a conventional laparoscopic appendectomy for the treatment of acute appendicitis. J Korean Soc Coloproctol 28:304–308CrossRefGoogle Scholar
  18. 18.
    Vilallonga R, Barbaros U, Nada A et al (2012) Single-port transumbilical laparoscopic appendectomy: a preliminary multicentric comparative study in 87 patients with acute appendicitis. Minim Invasive Surg 2012:492409PubMedCentralPubMedGoogle Scholar
  19. 19.
    Malik M, McCormack K, Krukowski ZH et al (2012) Single port/incision laparoscopic surgery compared with standard three-port laparoscopic surgery for appendicectomy: a randomised controlled trial. Trials 13:201PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Knott EM, Gasior AC, Holcomb GW III et al (2012) Impact of body habitus on single-site laparoscopic appendectomy for nonperforated appendicitis: subset analysis from a prospective, randomized trial. J Laparoendosc Adv Surg Tech A 22:404–407PubMedCrossRefGoogle Scholar
  21. 21.
    Perez EA, Piper H, Burkhalter LS et al (2013) Single-incision laparoscopic surgery in children: a randomized control trial of acute appendicitis. Surg Endosc 27:1367–1371PubMedCrossRefGoogle Scholar
  22. 22.
    St Peter SD, Adibe OO, Juang D et al (2011) Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg 254:586–590PubMedCrossRefGoogle Scholar
  23. 23.
    Frutos MD, Abrisqueta J, Lujan J et al (2013) Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg 257:413–418PubMedCrossRefGoogle Scholar
  24. 24.
    Kye BH, Lee J, Kim W et al (2013) Comparative study between single-incision and three-port laparoscopic appendectomy: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 23:431–436PubMedCrossRefGoogle Scholar
  25. 25.
    Lee WS, Choi ST, Lee JN et al (2013) Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: a prospective randomized controlled study. Ann Surg 257:214–218PubMedCrossRefGoogle Scholar
  26. 26.
    Park JH, Hyun KH, Park CH et al (2010) Laparoscopic vs transumbilical single-port laparoscopic appendectomy; results of prospective randomized trial. J Korean Surg Soc 78:213–218CrossRefGoogle Scholar
  27. 27.
    Sozutek A, Colak T, Dirlik M et al (2013) A prospective randomized comparison of single-port laparoscopic procedure with open and standard 3-port laparoscopic procedures in the treatment of acute appendicitis. Surg Laparosc Endosc Percutan Tech 23:74–78PubMedCrossRefGoogle Scholar
  28. 28.
    Teoh AY, Chiu PW, Wong TC et al (2012) A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy. Ann Surg 256:909–914PubMedCrossRefGoogle Scholar
  29. 29.
    Moreno-Sanz C, Morandeira-Rivas A, Morales-Conde S et al (2012) Single incision laparoscopic surgery: analysis of the national register. Cir Esp 90:298–309PubMedCrossRefGoogle Scholar
  30. 30.
    Rehman H, Ahmed I (2011) Technical approaches to single port/incision laparoscopic appendicectomy: a literature review. Ann R Coll Surg Engl 93:508–513PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Alptekin H, Yilmaz H, Acar F et al (2012) Incisional hernia rate may increase after single-port cholecystectomy. J Laparoendosc Adv Surg Tech A 22:731–737PubMedCrossRefGoogle Scholar
  32. 32.
    Marks JM, Phillips MS, Tacchino R et al (2013) Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg 216:1037–1047PubMedCrossRefGoogle Scholar
  33. 33.
    Swank HA, Eshuis EJ, van Berge Henegouwen MI et al (2011) Short- and long-term results of open versus laparoscopic appendectomy. World J Surg 35:1221–1226. doi: 10.1007/s00268-011-1088-5 PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Saad S, Strassel V, Sauerland S (2013) Randomized clinical trial of single-port, minilaparoscopic and conventional laparoscopic cholecystectomy. Br J Surg 100:339–349PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Michael Clerveus
    • 1
    Email author
  • Antonio Morandeira-Rivas
    • 1
  • Carlos Moreno-Sanz
    • 1
  • Maria Luz Herrero-Bogajo
    • 1
  • Joaquin Salvelio Picazo-Yeste
    • 1
  • Gloria Tadeo-Ruiz
    • 1
  1. 1.Department of Surgery“La Mancha Centro” General HospitalAlcázar de San JuanSpain

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