Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: A systematic review and meta-analysis

• Multiple port laparoscopic appendicectomy is commonly used in management of acute appendicitis.
• Single incision laparoscopic surgery could potentially offer less postoperative pain and better cosmesis.
• This review aims to ascertain any differences the two techniques.
• Single incision surgery could be a viable option in the hands of an experienced surgeons.
• It also could be of particular value for patients' who place great value on cosmesis.

BackgroundAppendicectomy is a well-established surgical procedure used in the management of acute appendicitis. The operation can be performed with minimally invasive surgery or as an open procedure. A further development in the minimally invasive appendicectomy technique has been the introduction of single incision laparoscopic surgery (SILA).AimTo ascertain any differences in outcomes from available trials comparing SILA with conventional multi-incision laparoscopic appendicectomy (CLA).MethodsA literature search of MEDLINE/PubMed, EMBASE/Ovid and CENTRAL for articles from Jan1990 to June 2015 with key words: ‘appendectomy’, ‘appendicetomy’; ‘appendicitis’; ‘laparoscopy’; ‘keyhole’; ‘single port’; ‘single incision’; ‘single site’; ‘one port’; ‘incisionless’; ‘scarless’. Randomised control trials of patients with signs and symptoms of appendicitis undergoing laparoscopic appendicectomy, with one arm being SILA were included. Statistical analysis was performed through Mantle-Haenszel and inverse variance methods.ResultsA total of 8 RCTs published between 2012 and 2014 with a total of 995 patients were included. Meta-analysis showed no significant differences between SILA and CLA for complication rates, post-operative ileus, length of hospital stay, return to work or post-operative pain. CLA was significantly superior to SILA with reduced operating time (mean difference 5.81 [2.01, 9.62] P = 0.003) and conversion rates (OR 4.14 [1.93, 8.91] P = 0.0003). SILA surgery had better wound cosmesis (mean difference 0.55 [0.33, 0.77] P = 0.00001).ConclusionSILA is comparable to CLA in terms of complications, post-operative pain and recovery. Therefore, SILA could be a viable option in the hands of an experienced surgeons and for patients' groups who place great value on the final cosmetic outcome.