Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: A systematic review and meta-analysis.

OE Aly, DH Black, H Rehman, I Ahmed

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


Background: Appendicectomy is a well-established surgical procedure used in the management of acute appendicitis. The operation can be performed with minimally invasive surgery or as an open procedure. A further development in the minimally invasive appendicectomy technique has been the introduction of single incision laparoscopic surgery (SILA).
Aim: To ascertain any differences in outcomes from available trials comparing SILA with conventional multi-incision laparoscopic appendicectomy (CLA).
Methods: A literature search of MEDLINE/PubMed, EMBASE/Ovid and CENTRAL for articles from Jan1990 to June 2015 with key words: ‘appendectomy’, ‘appendicetomy’; ‘appendicitis’; ‘laparoscopy’; ‘keyhole’; ‘single port’; ‘single incision’; ‘single site’; ‘one port’; ‘incisionless’; ‘scarless’. Randomised control trials of patients with signs and symptoms of appendicitis undergoing laparoscopic appendicectomy, with one arm being SILA were included. Statistical analysis was performed through Mantle-Haenszel and inverse variance methods.
Results: A total of 8 RCTs published between 2012 and 2014 with a total of 995 patients were included. Meta-analysis showed no significant differences between SILA and CLA for complication rates, post-operative ileus, length of hospital stay, return to work or post-operative pain. CLA was significantly superior to SILA with reduced operating time (mean difference 5.81 [2.01, 9.62] P = 0.003) and conversion rates (OR 4.14 [1.93, 8.91] P = 0.0003). SILA surgery had better wound cosmesis (mean difference 0.55 [0.33, 0.77] P = 0.00001).
Conclusion: SILA is comparable to CLA in terms of complications, post-operative pain and recovery. Therefore, SILA could be a viable option in the hands of an experienced surgeons and for patients' groups who place great value on the final cosmetic outcome.
Original languageEnglish
Pages (from-to)120-128
JournalInternational Journal of Surgery
Publication statusPublished - Nov 2016

Bibliographical note

Authors' contribution
OEA: Study design, database search, data extraction, data analysis and producing final manuscript.
DHB: Database search, data extraction, co-author.
HR: Study proposal, database search, hand-search of conference proceedings, contacting trial authors.
IA: Study conception, guided data collection and revised manuscript.

Submission for poster/presentation/conference
The abstract was presented as a poster the upcoming ASGBI 2016 Meeting in Dublin


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