Skip to main content
SpringerLink
Log in

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

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

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).

Methods

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.

Results

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.

Conclusion

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Heinzelmann M, Simmen HP, Cummins AS, Largiadèr F. Is laparoscopic appendectomy the new ‘gold standard’? Arch Surg 1995; 130:782–785.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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, 2008

    Chapter  Google Scholar 

  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. www.cebm.net/index.aspx?o=1025. Published 2009. Accessed May 22, 2013.

  22. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327:557–560.

    Article  PubMed  Google Scholar 

  23. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7:177–188.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  35. Blinman T. Incisions do not simply sum. Surg Endosc 2010; 24:1746–1751.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank all authors of the publications included in this study for contributing information, as required.

Grant support

None.

Author information

Authors and Affiliations

  1. Department of General Surgery, Shanghai Tenth People’s Hospital, Tongji University of Medicine, 301 Yanchang Middle Road, Shanghai, 200072, China

    Jie Hua, Jian Gong, Bin Xu, Tingsong Yang & Zhenshun Song

Authors
  1. Jie Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jian Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bin Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tingsong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhenshun Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhenshun Song.

Additional information

Jie Hua and Jian Gong contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hua, J., Gong, J., Xu, B. et al. Single-Incision Versus Conventional Laparoscopic Appendectomy: A Meta-analysis of Randomized Controlled Trials. J Gastrointest Surg 18, 426–436 (2014). https://doi.org/10.1007/s11605-013-2328-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2328-9

Keywords

Search

Navigation