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Single-incision Appendectomy is Comparable to Conventional Laparoscopic Appendectomy: A Systematic Review and Pooled Analysis

Gill, Richdeep S. MD*; Shi, Xinzhe MPH; Al-Adra, David P. MD*; Birch, Daniel W. MD, MSc, FRCSC; Karmali, Shahzeer MD, FRCSC

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: August 2012 - Volume 22 - Issue 4 - p 319–327
doi: 10.1097/SLE.0b013e31824f2cf8
Review Article

Purpose: Acute appendicitis remains the common gastrointestinal emergency in adults. Single-incision laparoscopic appendectomy (SILA) has been proposed as the next evolution in minimally invasive surgery. SILA is postulated to reduce postoperative pain and enhance cosmesis, while effectively removing an inflamed appendix. However, the efficacy and benefits of SILA compared with conventional laparoscopic appendectomy (CLA) remain to be determined. Our objectives were to systematically review the literature comparing SILA with CLA for acute appendicitis and perform a pooled analysis on the efficacy of SILA.

Methods: Published English-language manuscripts were considered for review inclusion. A comprehensive search of electronic databases (eg, MEDLINE, EMBASE, SCOPUS, BIOSIS Previews, and the Cochrane Library) using broad search terms was completed. All comparative studies were included if they incorporated adult patients undergoing appendectomy for acute appendicitis by SILA. The primary outcomes of interest were operative time and length of hospital stay.

Results: From a total of 366 articles, 34 articles were identified. A total of 9 comparative studies were included for pooled analysis. There was no significant difference in operative time, length of stay, pain scores, and conversion or complication rates between SILA and CLA for acute appendicitis.

Conclusions: This systematic review and pooled analysis demonstrates that SILA is comparable to CLA for acute appendicitis in adults. However, this review identifies the need for randomized controlled trials to clarify the efficacy of SILA compared with CLA.

*Department of Surgery, University of Alberta

Center for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandria Hospital, Edmonton, AB Canada

The authors declare no conflicts of interest.

Reprints: Shahzeer Karmali, MD, FRCSC, Royal Alexandra Hospital, Room 405, Community Services Center, 10240 Kingsway, Edmonton, AB T5H 3V9, Canada (e-mail: shahzeer@ualberta.ca).

Received June 8, 2011

Accepted February 7, 2012

© 2012 Lippincott Williams & Wilkins, Inc.