Acute appendicitis can be treated with single incision laparoscopy: a systematic review of randomized controlled trials

BACKGROUND: Single incision laparoscopic surgery (SILS) has been proposed as the next step in minimally invasive surgery for appendicectomy. Previous reviews have summarised the results of low evidence comparative studies suggest that the two approaches are comparable in terms of outcomes, but have proven the need for randomised controlled trials (RCTs). This review meta-analyses RCTs on this topic to evaluate the safety and efficacy of single incision laparoscopic appendectomy (SILA). METHODS: A comprehensive research of electronic databases has been performed. Primary outcomes (overall and access-specific morbidity) were designed as safety issues. Secondary outcomes were pain, cosmesis, operative time, conversion rate and length of hospital stay. RESULTS: FOLLOWING EXCLUSIONS, 5 RCTS SATISFIED THE INCLUSION CRITERIA, INCLUDING A TOTAL OF: 761 patients (379 SILA and 382 conventional three-port laparoscopic appendectomies - CLA). No significant differences in overall morbidity, early wound morbidity or length of stay were found between SILA and conventional three-port laparoscopic appendectomy (CLA). Cosmesis and pain were not comparable due to different scales and time records. Conclusions on incisional hernia rate were not reliable due to short follow-up periods. CONCLUSIONS: SILA can be considered an acceptable alternative to CLA in the treatment of acute appendicitis,but an economic evaluation of the various techniques for single access must be performed before its widespread clinical introduction. Better designed RCTs are necessary to define a population in which SILA could have major benefits. This article is protected by copyright. All rights reserved.