Comparison between single-incision and conventional three-port laparoscopic appendectomy: a meta-analysis from eight RCTs

To assess the efficacy and safety of single-incision laparoscopic appendectomy (SILA), we conducted a meta-analysis of randomized controlled trials (RCTs) comparing conventional three-port laparoscopic appendectomy (CTLA). RCTs comparing the effects of SILA and CTLA were searched for in PubMed, the Cochrane Central Register of Controlled Trials, and Embase. Operative time, the pain visual analogue scales scores (VAS scores), dose of analgesics, postoperative complications, hospital charges, and duration of postoperative hospitalization in SILA and CTLA were pooled and compared by meta-analysis. Odds ratios and weighted mean differences (WMDs) were calculated with 95 % confidence intervals (CIs) to evaluate the effect of SILA. Eight original RCTs investigating 760 adults and 684 children, 1,444 patients in total, of whom 721 received SILA only and 723 received CTLA only, met the inclusion criteria. Both in adults and children, the mean operative time was significantly longer in SILA than CTLA (WMD5.45, 95 % CI 2.15 to 8.75, p = 0.01). Compared with CTLA, in children, SILA have higher analgesic consumption (WMD 0.69, 95 % CI 0.08 to 1.3, p = 0.03) and greater hospital charges (WMD 0.87, 95 % CI 1.26 to 1.48, p = 0.005), which was not statistically different in adults (p > 0.05). Pooling the results for SILA and CTLA revealed no significant difference in VAS scores, wound infection rate, overall complications, and postoperative hospital stay. SILA failed to show any obvious advantages over CTLA in perioperative and postoperative outcomes. Therefore, it represents a possible alternative to conventional three-port laparoscopic appendectomy.