Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: evidence from randomized controlled trials and nonrandomized comparative studies

BACKGROUND: Single-port laparoscopic appendectomy (SPLA) has gained widespread acceptance and is increasingly performed. The evidence assessing the safety and efficacy of SPLA compared with conventional laparoscopic appendectomy (CLA) is growing; however, very few randomized trials exist and individual studies often have small patient numbers with varying results. We integrated the available data to enhance the current literature by comparing these techniques.

METHODS: A systematic review of the literature was performed to identify studies comparing SPLA and CLA. Operative parameters, postoperative outcomes, and postoperative complications were evaluated. Meta-analysis was performed using Review Manage Version 5.0 software.

RESULTS: Fifteen studies matched the selection criteria, including 1560 patients (46.1% SPLA, 53.9% CLA). SPLA was associated with longer operative time compared with CLA procedure (P=0.001). There were no significant statistical differences between the SPLA and CLA groups in terms of postoperative outcomes including postoperative visual analog scale pain scores (P=0.12), time to return to diet (P=0.45), time to flatus (P=0.89), leukocyte count (P=0.86) and C-reactive protein level (P=0.70) evaluation after operation, cosmetic satisfaction level (P=0.95), and length of hospital stay (P=0.16). The overall complication rates were not significantly different between the 2 groups (P=0.44). There was no evidence to suggest heterogeneity of trial results.

CONCLUSIONS: SPLA shows no benefit over CLA, including even parameters such as postoperative pain and cosmetic results, and, therefore, there is no indication to use this approach over standard laparoscopic appendectomy. SPLA does take longer to perform. Further studies are needed to confirm that the procedure is more costly.