Single-incision versus three-port laparoscopic appendectomy for acute appendicitis: systematic review and meta-analysis of randomized controlled trials
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Three-port laparoscopic appendectomy (TPLA) has been shown superior to open appendectomy for acute appendicitis (AA); alternatively, single-incision laparoscopic appendectomy (SILA) is gaining popularity. The choice between SILA and traditional TPLA remains controversial. This meta-analysis of high-quality randomized controlled trials (RCTs) aims to compare efficacy and safety of SILA with TPLA for AA.
We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs comparing SILA with TPLA. Reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases were also searched. Primary outcomes were operative time, postoperative complications, hospital duration, and days back to normal activities. Meta-analysis was conducted where possible comparing items using weighted mean differences (WMDs) and relative risks (RRs) according to type of data. Methodological quality was evaluated to assess bias risk.
A total of 8 distinct RCTs comparing SILA (n = 616) with TPLA (n = 618) published from 2010 to 2013 were identified in our analysis. SILA took longer to conduct than TPLA (43 vs 38, WMD: 5.96, 95 % CI 2.54–9.38, P = 0.0006). Patients undergoing SILA needed more extra trocars addressed during operation (7 % vs 0 %, RR: 12.36, 95 % CI 3.83–39.90, P < 0.0001), but could return to full activities earlier (6 vs 7, WMD: −0.68, 95 % CI −1.10 to −0.26, P = 0.001). However, these differences were not clinically significant. All other parameters were comparable.
These results provide level 1a support for the clinical similarity that SILA is basically as feasible, effective and safe as TPLA when dealing with AA, although statistically, SILA takes longer to perform, requires more extra trocars, and benefits patients with faster recovery compared with TPLA. Further RCTs are needed to update our finding with advancement of surgical techniques and skills.
KeywordsSingle-incision laparoscopic appendectomy Three-port laparoscopic appendectomy Acute appendicitis Efficacy Safety
This work was supported by: National Natural Science Foundation of China (81172036), and Foundation of Anhui Science and Technology Agency (12070403061). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We are grateful to the referees, and Profs. Wen-Xiu Han and Zhi-Jian Wei for critically reviewing this paper. We thank College of Public Hygiene of Anhui Medical University and the Information Center in the First Affiliated Hospital of Anhui Medical University for their contributions to our study.
Drs. A-Man Xu, Lei Huang, and Tuan-Jie Li have no conflicts of interest or financial ties to disclose.
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