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Meta-Analysis of Randomized Clinical Trials Comparing Intraumbilical Versus Periumbilical Incision in Laparoscopic
Justyna Mohr1, Pascal Probst2, Eva Kalkum3
1Department of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.
Background:
Laparoscopic appendectomy has become the standard treatment for acute appendicitis. However, surgical site infections still occur in up to 8% of patients. The aim of this review was to compare the short- and long-term outcomes of an intraumbilical incision with a periumbilical incision for umbilical port placement in laparoscopic appendectomy.
Methods:
A systematic literature search for randomized clinical trials (RCTs) was performed in CENTRAL, PubMed, Embase, and Web of Science (last search 10 January 2025). Four outcome variables provided sufficient data to allow for a meta-analysis using the random-effects model. Risk of bias (Cochrane 2.0) and certainty of evidence (GRADE) were assessed.
Results:
Six RCTs from Asia with 1576 patients were included. An intraumbilical incision may have little to no effect on operation time (MD -1.57 min, 95%-CI: -5.30 to 2.16, p = 0.41, I2 = 98%, and GRADE = very low) and length of hospital stay (MD 0.17 days, 95%-CI: -1.12 to 1.47, p = 0.79, I2 = 93%, and GRADE = very low). Moreover, the evidence suggests that an intraumbilical incision may result in little to no difference in internal organ injury (OR 0.69, 95%-CI: 0.33 to 1.43, p = 0.32, I2 = 0%, and GRADE = low) and umbilical surgical site infection (OR 0.76, 95%-CI: 0.40 to 1.44, p = 0.40, I2 = 22%, and GRADE = low). Five RCTs were assessed as having a high risk of bias, whereas one study raised some concerns.
Conclusions:
The evidence suggests that there is little to no difference in any of the clinical short-term outcomes between intraumbilical and periumbilical port placement in laparoscopic appendectomy. Surgeons should use their preferred approach. The body of evidence would benefit from a high-quality RCT in a western population and from data on long-term outcomes.
Trial Registration:
CRD42025628000 (PROSPERO).
Insights
This review found no significant difference in outcomes between intraumbilical and periumbilical incisions for laparoscopic appendectomy port placement. Surgeons can choose their preferred method for appendicitis treatment.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Laparoscopic appendectomy is standard for acute appendicitis, but surgical site infections occur in up to 8% of patients.
- Umbilical port placement is crucial for minimally invasive procedures.
- Variations in umbilical incision techniques may impact patient outcomes.
Purpose of the Study:
- To compare short- and long-term outcomes of intraumbilical versus periumbilical incisions for the umbilical port in laparoscopic appendectomy.
- To evaluate the impact of different umbilical port incision techniques on surgical site infections and other complications.
- To synthesize evidence from randomized clinical trials on umbilical port placement in appendectomy.
Main Methods:
- Systematic literature search of CENTRAL, PubMed, Embase, and Web of Science.
- Meta-analysis of four outcome variables using a random-effects model.
- Assessment of risk of bias (Cochrane 2.0) and certainty of evidence (GRADE).
Main Results:
- Six randomized clinical trials (RCTs) with 1576 patients were included.
- Intraumbilical incisions showed little to no effect on operation time and length of hospital stay (very low certainty evidence).
- No significant difference was found in internal organ injury or umbilical surgical site infections (low certainty evidence).
Conclusions:
- Current evidence suggests minimal difference in short-term clinical outcomes between intraumbilical and periumbilical port placement in laparoscopic appendectomy.
- Surgeons are advised to use their preferred approach for umbilical port placement.
- High-quality RCTs in Western populations and data on long-term outcomes are needed to strengthen the evidence base.
