Single-incision versus conventional multi-incision laparoscopic appendicectomy for suspected uncomplicated...

Area of Science:

• Minimally Invasive Surgery
• Surgical Techniques
• Gastrointestinal Surgery

Background:

• Appendicectomy for acute appendicitis has evolved from open to laparoscopic procedures.
• Single-incision laparoscopic appendicectomy (SILA) is a newer technique using a single incision.
• Comparisons between SILA and conventional laparoscopic appendicectomy (CLA) are ongoing.

Purpose of the Study:

• To compare SILA with CLA for appendicitis.
• To evaluate benefits, complications, and short-term outcomes.
• To update previous systematic reviews on SILA efficacy.

Main Methods:

• Systematic review of randomized controlled trials (RCTs).
• Searched multiple databases including CENTRAL, MEDLINE, and Embase up to January 2024.
• Included RCTs comparing SILA and CLA in patients over 10 years old.

Main Results:

• 11 RCTs with 1373 participants were analyzed.
• Pain scores at 24 hours were similar (low-certainty evidence).
• SILA showed superior cosmetic results (moderate-certainty evidence).
• Visceral/vascular injury rates were similar (moderate-certainty evidence).
• Higher conversion rates for SILA (low-certainty evidence).
• Increased additional port site use for SILA (moderate-certainty evidence).
• Marginally improved hospital stay with SILA (moderate-certainty evidence).
• Similar return to normal activities (moderate-certainty evidence).

Conclusions:

• SILA is comparable to CLA for appendicitis regarding complications and short-term outcomes.
• SILA may have a higher conversion rate but offers better cosmetic satisfaction.
• Evidence certainty is low to moderate, necessitating cautious interpretation.