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

Area of Science:

• Minimally Invasive Surgery
• Surgical Outcomes Research
• Gastrointestinal Surgery

Background:

• Single-port laparoscopic surgery (SPLS) offers potential cosmetic and recovery benefits over multi-port laparoscopic surgery (MPLS).
• The clinical utility of SPLS for emergency appendectomy, especially in complex scenarios, requires further investigation.

Purpose of the Study:

• To systematically review and meta-analyze the safety and effectiveness of SPLS versus MPLS for emergency appendectomy.
• To evaluate recent advancements and inform clinical decision-making regarding SPLS in appendectomy.

Main Methods:

• A systematic literature search was conducted across PubMed, Embase, and Cochrane Library.
• Studies comparing SPLS and MPLS for emergency appendectomy were analyzed for outcomes including conversion rates, operative time, complications, hospital stay, pain, and cosmetic satisfaction.
• Data synthesis followed PRISMA guidelines using a random-effects model.

Main Results:

• Eleven studies (RCTs and cohort studies) were included. No significant differences were found in conversion rates, complication rates, operative time, length of hospital stay, or postoperative pain.
• Significant heterogeneity was noted for operative time, length of stay, and pain outcomes.
• Cosmetic satisfaction generally favored SPLS, though assessment methods varied.

Conclusions:

• SPLS is a safe and feasible option for emergency appendectomy compared to MPLS.
• Current evidence is limited by heterogeneity, small study sizes, and inconsistent outcome measures, precluding definitive conclusions on equivalence.
• Large-scale randomized trials are needed to clarify the role of SPLS, particularly in complex appendicitis cases and high-risk patient groups.