Single-port vs multi-port laparoscopic appendectomy in acute appendicitis: a systematic review

Single-port laparoscopic surgery (SPLS) is a promising alternative to multi-port laparoscopic surgery (MPLS) for emergency appendectomy, with potential advantages in cosmesis and recovery. However, its role remains uncertain, particularly in complex cases. This systematic review and meta-analysis evaluates SPLS's safety, effectiveness, and recent advancements to inform clinical decisions and practice.

A systematic search of PubMed, Embase, and Cochrane Library identified studies comparing SPLS with MPLS in emergency appendectomy. Outcomes included conversion to open surgery, operative time, postoperative complications, length of hospital stay, pain outcomes, and cosmetic satisfaction. Data synthesis followed PRISMA guidelines using a random-effects model.

Eleven studies, including randomized controlled trials and cohort studies, were included. No significant differences were observed in conversion rates (OR 1.78, 95% CI: 0.63-5.03), complication rates (OR 0.96, 95% CI: 0.63-1.46), operative time (mean difference 2.93 min, 95% CI: - 3.17 to 9.02), length of stay (mean difference - 0.23 days, 95% CI: - 0.62 to 0.15), or postoperative pain (mean difference - 0.24, 95% CI: - 0.96 to 0.49). Substantial heterogeneity was present for operative time (I² = 91%), length of stay (I² = 92%), and pain (I² = 80%). Cosmetic satisfaction generally favoured SPLS, although assessment methods varied considerably.

While SPLS appears to be a safe and feasible alternative to MPLS for emergency appendectomy, current evidence does not support definitive equivalence across all outcomes due to significant heterogeneity, small study sizes, and inconsistent measurement tools. Future large-scale randomized trials are necessary to clarify SPLS's role, especially in complex cases and high-risk populations.