Journal of Gastrointestinal Surgery

, Volume 18, Issue 2, pp 426–436

Single-Incision Versus Conventional Laparoscopic Appendectomy: A Meta-analysis of Randomized Controlled Trials

  • Jie Hua
  • Jian Gong
  • Bin Xu
  • Tingsong Yang
  • Zhenshun Song
Review Article



Single-incision laparoscopic appendectomy (SILA) has gained enormous popularity worldwide. We conducted a meta-analysis to assess feasibility, safety, and benefits of SILA as compared with conventional laparoscopic appendectomy (CLA).


A literature search in MEDLINE, EMBASE, and Cochrane Library was performed to identify eligible randomized controlled trials (RCTs). Primary outcome measures were total postoperative complications, wound infection, intra-abdominal abscess, and ileus. Secondary outcome measures were operative time, length of hospital stay, pain scores, conversion rate, reoperation rate, and time to return to normal activity.


Eight RCTs, totaling 1,211 patients (604 for SILA and 607 for CLA), met the inclusion criteria. The incidences of total postoperative complications, wound infection, intra-abdominal abscess, and ileus were statistically similar between the SILA and CLA groups. Compared with CLA, SILA was associated with a significantly longer operative time (weighted mean difference = 5.28 min; 95 % confidence interval = 3.61 to 6.94). Time to return to normal activity was shorter in the SILA group (by 0.69 days). Length of hospital stay, pain scores, conversion rate, and reoperation rate were similar between groups.


SILA is feasible and safe with no obvious advantages over CLA. Therefore, it may be considered as an alternative to CLA.


Single-incision laparoscopic appendectomy Conventional three-port laparoscopic appendectomy Appendicitis Meta-analysis 


  1. 1.
    Heinzelmann M, Simmen HP, Cummins AS, Largiadèr F. Is laparoscopic appendectomy the new ‘gold standard’? Arch Surg 1995; 130:782–785.PubMedCrossRefGoogle Scholar
  2. 2.
    Kehagias I, Karamanakos SN, Panagiotopoulos S, Panagopoulos K, Kalfarentzos F. Laparoscopic versus open appendectomy: which way to go? World J Gastroenterol 2008; 14:4909–4914.PubMedCrossRefGoogle Scholar
  3. 3.
    Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, Wei HB. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc 2011; 25:1199–1208.PubMedCrossRefGoogle Scholar
  4. 4.
    Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K. Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis. J Gastrointest Surg 2012; 16:1929–1939.PubMedCrossRefGoogle Scholar
  5. 5.
    Lee PC, Lo C, Lai PS, Chang JJ, Huang SJ, Lin MT, Lee PH. Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg 2010; 97:1007–1012.PubMedCrossRefGoogle Scholar
  6. 6.
    Saber AA, El-Ghazaly TH, Elain A, Dewoolkar AV. Single-incision laparoscopic placement of an adjustable gastric band versus conventional multiport laparoscopic gastric banding: a comparative study. Am Surg 2010; 76:1328–1332.PubMedGoogle Scholar
  7. 7.
    Walz MK, Groeben H, Alesina PF. Single-access retroperitoneoscopic adrenalectomy (SARA) versus conventional retroperitoneoscopic adrenalectomy (CORA): a case–control study. World J Surg 2010; 34:1386–1390.PubMedCrossRefGoogle Scholar
  8. 8.
    Raman JD, Bagrodia A, Cadeddu JA. Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 2009; 55:1198–1204.PubMedCrossRefGoogle Scholar
  9. 9.
    Teoh AY, Chiu PW, Wong TC, Wong SK, Lai PB, Ng EK. A case-controlled comparison of single-site access versus conventional three-port laparoscopic appendectomy. Surg Endosc 2011; 25:1415–1419.PubMedCrossRefGoogle Scholar
  10. 10.
    St Peter SD, Adibe OO, Juang D, Sharp SW, Garey CL, Laituri CA, Murphy JP, Andrews WS, Sharp RJ, Snyder CL, Holcomb GW 3rd, Ostlie DJ. Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg 2011; 254:586–590.PubMedCrossRefGoogle Scholar
  11. 11.
    Gill RS, Shi X, Al-Adra DP, Birch DW, Karmali S. Single-incision appendectomy is comparable to conventional laparoscopic appendectomy: a systematic review and pooled analysis. Surg Laparosc Endosc Percutan Tech 2012; 22:319–327.PubMedCrossRefGoogle Scholar
  12. 12.
    Pisanu A, Porceddu G, Reccia I, Saba A, Uccheddu A. Meta-analysis of studies comparing single-incision laparoscopic appendectomy and conventional multiport laparoscopic appendectomy. J Surg Res 2013; pii: S0022-4804(13)00232-1.Google Scholar
  13. 13.
    Sozutek A, Colak T, Dirlik M, Ocal K, Turkmenoglu O, Dag A. 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 2013; 23:74–78.PubMedCrossRefGoogle Scholar
  14. 14.
    Kye BH, Lee J, Kim W, Kim D, Lee D. Comparative study between single-incision and three-port laparoscopic appendectomy: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 2013; 23:431–436.PubMedCrossRefGoogle Scholar
  15. 15.
    Frutos MD, Abrisqueta J, Lujan J, Abellan I, Parrilla P. Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg 2013; 257:413–418.PubMedCrossRefGoogle Scholar
  16. 16.
    Lee WS, Choi ST, Lee JN, Kim KK, Park YH, Lee WK, Baek JH, Lee TH. Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: a prospective randomized controlled study. Ann Surg 2013; 257:214–218.PubMedCrossRefGoogle Scholar
  17. 17.
    Teoh AY, Chiu PW, Wong TC, Poon MC, Wong SK, Leong HT, Lai PB, Ng EK. A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy. Ann Surg 2012; 256:909–914.PubMedCrossRefGoogle Scholar
  18. 18.
    Perez EA, Piper H, Burkhalter LS, Fischer AC. Single-incision laparoscopic surgery in children: a randomized control trial of acute appendicitis. Surg Endosc 2013; 27:1367–1371.PubMedCrossRefGoogle Scholar
  19. 19.
    Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339:b2535.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Higgins JPT, Altman DG, Sterne JAC. Assessing risk of bias in included studies. In: Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions version 5.1.0. United Kingdom: The Cochrane Collaboration, 2008CrossRefGoogle Scholar
  21. 21.
    Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M. Oxford Centre for Evidence-based Medicine—Levels of Evidence. Second Edition. Published 2009. Accessed May 22, 2013.
  22. 22.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327:557–560.PubMedCrossRefGoogle Scholar
  23. 23.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7:177–188.PubMedCrossRefGoogle Scholar
  24. 24.
    Park JH, Hyun KH, Park CH, Choi SY, Choi WH, Kim DJ, Lee S, Kim JS. Laparoscopic vs Transumbilical Single-Port Laparoscopic Appendectomy; Results of Prospective Randomized Trial. J Korean Surg Soc 2010; 78:213–218.CrossRefGoogle Scholar
  25. 25.
    Garey CL, Laituri CA, Ostlie DJ, Snyder CL, Andrews WS, Holcomb GW 3rd, St Peter SD. Single-incision laparoscopic surgery in children: initial single-center experience. J Pediatr Surg 2011; 46:904–907.PubMedCrossRefGoogle Scholar
  26. 26.
    Ponsky TA, Diluciano J, Chwals W, Parry R, Boulanger S. Early experience with single-port laparoscopic surgery in children. J Laparoendosc Adv Surg Tech A 2009; 19:551–553.PubMedCrossRefGoogle Scholar
  27. 27.
    Muensterer OJ, Puga Nougues C, Adibe OO, Amin SR, Georgeson KE, Harmon CM. Appendectomy using single-incision pediatric endosurgery for acute and perforated appendicitis. Surg Endosc 2010; 24:3201–3204.PubMedCrossRefGoogle Scholar
  28. 28.
    Grewal H, Sweat J, Vazquez WD. Laparoscopic appendectomy in children can be done as a fast-track or same-day surgery. JSLS 2004; 8:151–154.PubMedCentralPubMedGoogle Scholar
  29. 29.
    Alkhoury F, Burnweit C, Malvezzi L, Knight C, Diana J, Pasaron R, Mora J, Nazarey P, Aserlind A, Stylianos S. A prospective study of safety and satisfaction with same-day discharge after laparoscopic appendectomy for acute appendicitis. J Pediatr Surg 2012; 47:313–316.PubMedCrossRefGoogle Scholar
  30. 30.
    Alkhoury F, Malvezzi L, Knight CG, Diana J, Pasaron R, Mora J, Aserlind A, Stylianos S, Burnweit C. Routine same-day discharge after acute or interval appendectomy in children: a prospective study. Arch Surg 2012; 147:443–446.PubMedCrossRefGoogle Scholar
  31. 31.
    Kim HJ, Lee JI, Lee YS, Lee IK, Park JH, Lee SK, Kang WK, Cho HM, You YK, Oh ST. Single-port transumbilical laparoscopic appendectomy: 43 consecutive cases. Surg Endosc 2010; 24:2765–2769.PubMedCrossRefGoogle Scholar
  32. 32.
    Lee SY, Lee HM, Hsieh CS, Chuang JH. Transumbilical laparoscopic appendectomy for acute appendicitis: a reliable one-port procedure. Surg Endosc 2011; 25:1115–1120.PubMedCrossRefGoogle Scholar
  33. 33.
    Garg P, Thakur JD, Garg M, Menon GR. Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg 2012; 16:1618–1628.PubMedCrossRefGoogle Scholar
  34. 34.
    Zhong X, Rui YY, Zhou ZG. Laparoendoscopic single-site versus traditional laparoscopic surgery in patients with cholecystectomy: a meta-analysis. J Laparoendosc Adv Surg Tech A 2012; 22:449–455.PubMedCrossRefGoogle Scholar
  35. 35.
    Blinman T. Incisions do not simply sum. Surg Endosc 2010; 24:1746–1751.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Jie Hua
    • 1
  • Jian Gong
    • 1
  • Bin Xu
    • 1
  • Tingsong Yang
    • 1
  • Zhenshun Song
    • 1
  1. 1.Department of General Surgery, Shanghai Tenth People’s HospitalTongji University of MedicineShanghaiChina

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