Laparoscopic Appendectomy: Single Site Incision Or Conventional Procedure, A Meta-analysis

Background:Single incision laparoscopic surgery (SILS) is a rapidly developing field that may represent the future of laparoscopic surgery. It is a new technique that uses a single incision, preferably in the umbilicus, to perform laparoscopic operations without the need for additional incisions. Its potential advantages include the cosmetic outcome, rapid wound healing, a favorable postoperative pain score, and greater patient satisfaction. The safety and technical feasibility of SILS have been confirmed for a variety of surgical indications. Therefore, the standard in laparoscopic appendectomy may well change from conventional three-port laparoscopy to single-incision laparoscopic appendectomy (SILA). However, the safety and efficacy of SILA in comparison with the CLA has not been conclusively determined. Several trials have been conducted to address the controversy and concerns, yet the sample sizes of those studies are not large enough to produce statistically valid findings. Although there have been many reports in the literature on SILS, most have been retrospective studies and have considered the technical aspects of the procedure. There have been few prospective randomized studies of differences in the clinical outcomes results of single incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA)Objective:The purpose of this study is to evaluate the potential benefits and to compare the outcomes of Single incision laparoscopic appendectomy (SILA) when compared with conventional laparoscopic appendectomy (CLA).Methods:Various RCTs comparing the outcomes and effect of SILA and CLA were searched for in Pubmed, Embase, Web of science etc. Two reviewers completed article search and eligible data were entered into computerized sheet for meta-analysis. Data were pooled by weighted mean differences (VVMDs) or Odds Ratio (OR) with their 95% confidence interval.Results:Seven studies were obtained using search strategy, which included a total of 930 patients,466 in SILA group and 464 in CLA group. In our study results indicated no significant differences between SILA and CLA in terms of postoperative complications such as wound infection, post-operative ileus, incisional hernia, postoperative pain and length of hospital stay. However SILA was associated with significantly longer operative times (WMD=5.12; 95% Cl=1.05 to 9.19, P=0.01) than CLA. The conversion to additional port or open, the rate was significantly higher in patients who received SILA than CLA (OR=3.41; 95% Cl=1.61 to 7.23, P=0.001). Cosmetic results favored SILA group, the cosmetic scores were significantly higher in the SILA group than in the CLA group (Weighted mean differences WMD=0.58;95% Cl=0.38 to 4.17, P<0.02).Conclusions:Single Incision Laparoscopic appendectomy SILA can be safely performed with better cosmetic results than CLA; however it carries a higher conversion rate and longer operative time and doesn’t offers any significant differences in terms of wound infection, post operative ileus, incisional hernia, postoperative pain and length of hospital stay. Further RCTs in large scale are needed to determine their potential benefits between the two groups.