Meta-analysis of studies comparing single-incision laparoscopic appendectomy and conventional multiport laparoscopic appendectomy.

BACKGROUND: There is no consensus that single-incision laparoscopic appendectomy (SILS-A) is on a par with conventional multiport laparoscopic appendectomy (CMLA). The aim of this meta-analysis was to assess feasibility, safety, and potential benefits of SILS-A when compared with CMLA.

METHODS: A literature search for studies comparing SILS-A and CMLA was performed. Studies were reviewed for the outcome of interest: patient characteristics, operative outcome, postoperative recovery, postoperative morbidity, patient satisfaction, and cosmetic results.

RESULTS: Thirteen studies comparing SILS-A and CMLA were reviewed: two prospective randomized trials, four prospective studies, and seven retrospective studies. Overall, 893 patients were operated on: by SILS-A in 402 cases (45.0%) versus 491 cases (55.0%) by CMLA. Patients in the SILS-A group were significantly younger than those in the CMLA group (31.2 versus 33.5 y). No other differences were found. Patient satisfaction score was impossible to meta-analyze.

CONCLUSIONS: Appendectomy via SILS-A may be considered as an alternative to CMLA. However, these results must be approached with caution as they are based on data from nonrandomized observational studies. The feasibility and safety of SILS-A must be mainly assessed for difficult clinical situations such as severe obesity, localized abscess, or diffuse peritonitis from a ruptured appendix in the setting of new prospective randomized trials.