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Published on: February 28, 2025
Systematic review and meta-analysis of single-incision versus conventional laparoscopic appendectomy in children
Ze Zhang1, Yanan Wang1, Ruoyan Liu1
1Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Insights
Single-incision laparoscopic appendectomy (SILA) in children shows a higher wound infection rate and longer operative time compared to conventional multiport laparoscopic appendectomy (CLA). SILA is feasible but not superior, suggesting it may not be the preferred approach for pediatric appendectomies.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Single-incision laparoscopic appendectomy (SILA) is increasingly used in adults with outcomes comparable to conventional multiport laparoscopic appendectomy (CLA).
- The application and comparative efficacy of SILA versus CLA in pediatric patients remain controversial.
- A lack of systematic reviews comparing SILA and CLA in children necessitates further investigation.
Purpose of the Study:
- To systematically compare the safety and efficacy of SILA versus CLA in pediatric appendectomy.
- To evaluate key postoperative outcomes, including complications, operative time, and hospital stay.
Main Methods:
- A comprehensive literature search was conducted across major databases (MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov) from January 1998 to September 2014.
- Included studies involved pediatric patients undergoing either SILA or CLA for appendectomy.
- Meta-analysis utilized a random effects model to assess primary outcomes (complications, wound infection, abscess, ileus, hematoma) and secondary outcomes (operative time, hospital stay, analgesic use).
Main Results:
- The meta-analysis included 14 studies with 2249 pediatric patients (744 SILA, 1505 CLA).
- No significant differences were found in overall postoperative complications, intra-abdominal abscess, ileus, wound hematoma, hospital stay, or analgesic use.
- SILA was associated with a significantly higher incidence of wound infection (OR=2.25) and a longer operative time (WMD=5.73 minutes) compared to CLA.
Conclusions:
- Single-incision laparoscopic appendectomy (SILA) is a feasible procedure in pediatric patients but does not offer superiority over conventional multiport laparoscopic appendectomy (CLA).
- The increased risk of wound infection and longer operative time associated with SILA suggest it may not be the optimal surgical approach for pediatric appendectomies.
- Further research may be warranted to refine SILA techniques or identify patient subgroups who might benefit.
Background:
Increasing evidence has indicated that single-incision laparoscopic appendectomy (SILA) is a safe procedure that has a comparable clinical outcome to conventional multiport laparoscopic appendectomy (CLA) in adult patients. Nevertheless, the use of SILA in pediatric patients is still controversial, and systematic reviews that compare SILA and CLA in children are lacking in the current literature.
Methods:
A literature search in MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov was performed to identify eligible studies that were conducted between January 1998 and September 2014. Primary outcome measures were total postoperative complications, wound infection, intra-abdominal abscess, ileus, and wound hematoma. Secondary outcome measures were operative time, length of hospital stay and the frequency of use of additional analgesics. The random effect model was used for the meta-analysis.
Results:
The literature search identified 2 randomized clinical trials and 12 nonrandomized clinical trials that met the inclusion criteria for the meta-analysis. These studies included a total of 2249 patients: 744 who underwent SILA and 1505 who underwent CLA. No significant differences were observed between the groups with respect to the incidence of total postoperative complications, intraabdominal abscess, ileus, wound hematoma, length of hospital stay, or the frequency of use of additional analgesics. However, SILA was associated with a higher incidence of wound infection (OR=2.25; 95%=1.21-4.17; P=0.01) compared with CLA and required a longer operative time (WMD=5.73 minutes; 95% CI=4.17-7.28; P<0.00001).
Conclusions:
SILA seems to be a relatively feasible and safe procedure without any superiority to CLA. Thus, SILA may not be a better approach for pediatric patients.
