Abstract
Purpose
To assess the efficacy and safety of single-incision laparoscopic appendectomy (SILA), we conducted a meta-analysis of randomized controlled trials (RCTs) comparing conventional three-port laparoscopic appendectomy (CTLA).
Methods
RCTs comparing the effects of SILA and CTLA were searched for in PubMed, the Cochrane Central Register of Controlled Trials, and Embase. Operative time, the pain visual analogue scales scores (VAS scores), dose of analgesics, postoperative complications, hospital charges, and duration of postoperative hospitalization in SILA and CTLA were pooled and compared by meta-analysis. Odds ratios and weighted mean differences (WMDs) were calculated with 95 % confidence intervals (CIs) to evaluate the effect of SILA.
Result
Eight original RCTs investigating 760 adults and 684 children, 1,444 patients in total, of whom 721 received SILA only and 723 received CTLA only, met the inclusion criteria. Both in adults and children, the mean operative time was significantly longer in SILA than CTLA (WMD5.45, 95 % CI 2.15 to 8.75, p = 0.01). Compared with CTLA, in children, SILA have higher analgesic consumption (WMD 0.69, 95 % CI 0.08 to 1.3, p = 0.03) and greater hospital charges (WMD 0.87, 95 % CI 1.26 to 1.48, p = 0.005), which was not statistically different in adults (p > 0.05). Pooling the results for SILA and CTLA revealed no significant difference in VAS scores, wound infection rate, overall complications, and postoperative hospital stay.
Conclusion
SILA failed to show any obvious advantages over CTLA in perioperative and postoperative outcomes. Therefore, it represents a possible alternative to conventional three-port laparoscopic appendectomy.
Similar content being viewed by others
Abbreviations
- CTLA:
-
Conventional three-port laparoscopic appendectomy
- SILA:
-
Single-incision laparoscopic appendectomy
- VAS:
-
Visual analogue scales
References
Lee JH, Park YS, Choi JS (2010) The epidemiology of appendicitis and appendectomy in South Korea: national registry data. J Epidemiol 20:97–105
Noudeh YJ, Sadigh N, Ahmadnia AY (2007) Epidemiologic features, seasonal variations and false positive rate of acute appendicitis in Shahr-e-Rey, Tehran. Int J Surg 5:95–98
Addiss DG, Shaffer N, Fowler BS et al (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925
McBurney C IV (1894) The incision made in the abdominal wall in cases of appendicitis with a description of a new method of operating. Ann Surg 20:38–43
Payne SR, Ford TF, Wickham JE (1985) Endoscopic management of upper urinary tract stones. Br J Surg 72(10):822–824
Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64
Wei HB, Huang JL, Zheng ZH et al (2010) Laparoscopic versus open appendectomy a prospective randomized comparison. Surg Endosc 24:266–269
Luj´an JA, Robles R, Parrilla P et al (1994) Laparoscopic versus open appendicectomy a prospective assessment. Br J Surg 81:133–135
Kehagias I, Karamanakos SN, Panagiotopoulos S et al (2008) Laparoscopic versus open appendectomy: which way to go? World J Gastroenterol 14:4909–4914
Katsuno G, Nagakari K, Yoshikawa S et al (2009) Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy. World J Surg 33:208–214
Ignacio RC, Burke R, Spencer D et al (2004) Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc 18:334–337
De la Fuente SG, Demaria EJ, Reynolds JD et al (2007) New developments in surgery: natural orifice transluminal endoscopic surgery (NOTES). Arch Surg 142:295–297
Muneer A, Blick C, Sharma D et al (2008) Natural orifice transluminal endoscopic surgery: a new dimension in minimally invasive surgery. Expert Rev Gastroenterol Hepatol 2:155–157
Shin EJ, Jeong GA, Jung JC et al (2010) Transvaginal endoscopic appendectomy. J Korean Soc Coloproctol 26:429–432
Moreira-Pinto J, Lima E, Correia-Pinto J, Rolanda C (2011) Natural orifice transluminal endoscopy surgery: a review. World J Gastroenterol 17:3795–3801
Cho MS, Min BS, Hong YK et al (2011) Single-site versus conventional laparoscopic appendectomy: comparison of short-term operative outcomes. Surg Endosc 25:36–40
Chow A, Purkayastha S, Nehme J et al (2010) Single incision laparoscopic surgery for appendicectomy: a retrospective comparative analysis. Surg Endosc 24:2567–2574
Yu J, Wang YN, Hu YF et al (2011) Single-incision laparoscopic appendectomy performed above the pubic symphysis—a new scarless approach. Minim Invasive Ther Allied Technol 20:18–21
Raakow R, Jacob DA (2011) Initial experience in laparoscopic single-port appendectomy: a pilot study. Dig Surg 28:74–79
Prasad A (2010) Single incision laparoscopic surgery. World J Gastroenterol 16:2705–2706
Lee JA, Sung KY, Lee JH, Lee DS (2010) Laparoscopic appendectomy with a single incision in a single institute. J Korean Soc Coloproctol 26:260–264
Kang KC, Lee SY, Kang DB et al (2010) Application of single incision laparoscopic surgery for appendectomies in patients with complicated appendicitis. J Korean Soc Coloproctol 26:388–394
Udwadia TE (2011) Single-incision laparoscopic surgery: an overview. J Minim Access Surg 7:1–2
Rao PP, Bhagwat S (2011) Single-incision laparoscopic surgery—current status and controversies. J Minim Access Surg 7:6–16
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 23:431–436
Frutos MD, Abrisqueta J, Lujan J et al (2013) Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg 257(3):413–418
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(1):74–78
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(2):214–218
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(6):909–914
Knott EM, Gasior AC, Holcomb GW 3rd et al (2012) Impact of body habitus on single-site laparoscopic appendectomy for nonperforated appendicitis: subset analysis from prospective, randomized trial. J Laparoendosc Adv Surg Tech A 22(4):404–407
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(4):1367–1371
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(4):586–590
Katkhouda N, Mason RJ, Towfigh S et al (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242:439–448, discussion 448–450
Disclosure statement
No competing financial interests exist.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gao, J., Li, P., Li, Q. et al. Comparison between single-incision and conventional three-port laparoscopic appendectomy: a meta-analysis from eight RCTs. Int J Colorectal Dis 28, 1319–1327 (2013). https://doi.org/10.1007/s00384-013-1726-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-013-1726-5