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World J Gastroenterol. Aug 21, 2013; 19(31): 5165-5173
Published online Aug 21, 2013. doi: 10.3748/wjg.v19.i31.5165
Single-incision laparoscopic appendectomy vs conventional laparoscopic appendectomy: Systematic review and meta-analysis
Yu-Long Cai, Xian-Ze Xiong, Si-Jia Wu, Yao Cheng, Jiong Lu, Jie Zhang, Yi-Xin Lin, Nan-Sheng Cheng
Yu-Long Cai, Xian-Ze Xiong, Si-Jia Wu, Yao Cheng, Jiong Lu, Jie Zhang, Yi-Xin Lin, Nan-Sheng Cheng, Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Cai YL and Cheng NS designed the study; Wu SJ, Cheng Y and Lu J performed the literature searchand collected the data; Zhang J and Lin YX analyzed the data; Cai YL and Xiong XZ wrote the paper.
Correspondence to: Nan-Sheng Cheng, MD, Professor, Department of Bile Duct Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan Province, China.
Telephone: +86-28-85422461 Fax: +86-28-85422462
Received: February 21, 2013
Revised: July 4, 2013
Accepted: July 9, 2013
Published online: August 21, 2013

AIM: To assess the differences in clinical benefits and disadvantages of single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA).

METHODS: The Cochrane Library, MEDLINE, Embase, Science Citation Index Expanded, and Chinese Biomedical Literature Database were electronically searched up through January 2013 to identify randomized controlled trails (RCTs) comparing SILA with CLA. Data was extracted from eligible studies to evaluate the pooled outcome effects for the total of 1068 patients. The meta-analysis was performed using Review Manager 5.2.0. For dichotomous data and continuous data, the risk ratio (RR) and the mean difference (MD) were calculated, respectively, with 95%CI for both. For continuous outcomes with different measurement scales in different RCTs, the standardized mean difference (SMD) was calculated with 95%CI. Sensitivity and subgroup analyses were performed when necessary.

RESULTS: Six RCTs were identified that compared SILA (n = 535) with CLA (n = 533). Five RCTs had a high risk of bias and one RCT had a low risk of bias. SILA was associated with longer operative time (MD = 5.68, 95%CI: 3.91-7.46, P < 0.00001), higher conversion rate (RR = 5.14, 95%CI: 1.25-21.10, P = 0.03) and better cosmetic satisfaction score (MD = 0.52, 95%CI: 0.30-0.73, P < 0.00001) compared with CLA. No significant differences were found for total complications (RR = 1.15, 95%CI: 0.76-1.75, P = 0.51), drain insertion (RR = 0.72, 95%CI: 0.41-1.25, P = 0.24), or length of hospital stay (SMD = 0.04, 95%CI: -0.08-0.16, P = 0.57). Because there was not enough data among the analyzed RCTs, postoperative pain was not calculated.

CONCLUSION: The benefit of SILA is cosmetic satisfaction, while the disadvantages of SILA are longer operative time and higher conversion rate.

Keywords: Single incision, Laparoscopic, Appendectomy, Meta-analysis, Systematic review

Core tip: The clinical benefit of single-incision laparoscopic appendectomy (SILA), compared to the conventional three-port laparoscopic appendectomy, has been a controversial issue in recent years. We performed the first systematic review and meta-analysis of randomized controlled trails (RCTs) that have assessed the clinical benefits and disadvantages between SILA and conventional laparoscopic appendectomy (CLA). Six RCTs conducted between 2011 and 2013 were identified and pooled to determine outcomes using meta-analytic methods. From this analysis, we conclude that SILA is as safe as CLA. Although patients receiving SILA had longer operative times and a higher conversion rate, one benefit of SILA is cosmetic satisfaction.