Meta-Analysis
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 7, 2013; 19(25): 4072-4082
Published online Jul 7, 2013. doi: 10.3748/wjg.v19.i25.4072
Safety and efficacy of single-incision laparoscopic surgery for appendectomies: A meta-analysis
Ping Li, Zong-Hui Chen, Qing-Guo Li, Tang Qiao, You-Yong Tian, Dao-Rong Wang
Ping Li, Qing-Guo Li, Tang Qiao, Dao-Rong Wang, Department of Gastrointestinal Surgery, Subei People’s Hospital of Jiangsu Province (the First Affiliated Hospital of Yangzhou University), Yangzhou 225001, Jiangsu Province, China
Zong-Hui Chen, You-Yong Tian, Department of Neurology, Nanjing First Hospital (the Third Affiliated Hospital of Nanjing Medical University), Nanjing 211166, Jiangsu Province, China
Author contributions: Li P and Chen ZH contributed equally to this study; Tian YY and Wang DR provided supervision; Li P, Li QG and Qiao T identified and acquired reports of trials, abstracted the data and assessed the risk of bias; Li P conducted the statistical analyses and contacted authors of included studies to obtain additional information; Li P drafted the manuscript; and all the authors contributed to the interpretation of data, critically revised the manuscript and approved the final version of the manuscript submitted for publication and are guarantors for the study.
Supported by National Natural Science Foundation of China, No. 81201885 and No. 81172279
Correspondence to: Dao-Rong Wang, MD, PhD, Department of Gastrointestinal Surgery, Subei People’s Hospital of Jiangsu Province (the First Affiliated Hospital of Yangzhou University), 98 Nantong West Road, Yangzhou 225001, Jiangsu Province, China. 734909944@qq.com
Telephone: +86-25-87373285 Fax: +86-514-87373285
Received: February 7, 2013
Revised: March 20, 2013
Accepted: May 7, 2013
Published online: July 7, 2013
Processing time: 149 Days and 4.7 Hours
Abstract

AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons.

METHODS: Studies and relevant literature regarding the performance of single-incision laparoscopic surgery vs conventional laparoscopic surgery for appendectomy were searched for in the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, EMBASE and World Health Organization international trial register. The operation time (OR time), complications, wound infection and postoperative day using SILS-A or C-LA were pooled and compared using a meta-analysis. The risk ratios and mean differences were calculated with 95%CIs to evaluate the effect of SILS-A.

RESULTS: Sixteen recent studies including 1624 patients were included in this meta-analysis. These studies demonstrated that, compared with C-LA, SILS-A has a similar OR time in adults but needs a longer OR time in children. SILS-A has similar complications, wound infection and length of the postoperative day in adults and children, and required similar doses of narcotics in children, the pooled mean different of -0.14 [95%CI: -2.73-(-2.45), P > 0.05], the pooled mean different of 11.47 (95%CI: 10.84-12.09, P < 0.001), a pooled RR of 1.15 (95%CI: 0.72-1.83, P > 0.05), a pooled RR of 1.9 (95%CI: 0.92-3.91, P > 0.05), a pooled RR of 1.01 (95%CI: 0.51-2.0, P > 0.05) a pooled RR of 1.86 (95%CI: 0.77-4.48, P > 0.05), the pooled mean different of -0.25 (95%CI: -0.50-0, P = 0.05) the pooled mean different of -0.01 (95%CI: -0.05-0.04, P > 0.05) the pooled mean different of -0.13 (95%CI: -0.49-0.23, P > 0.05) respectively.

CONCLUSION: SILS-A is a technically feasible and reliable approach with short-term results similar to those obtained with the C-LA procedure.

Keywords: Single incision; Laparoscopy; Appendicitis; Children; Adult

Core tip: Single incision laparoscopic surgery for an appendectomy (SILS-A) is widely accepted and has become the best option for treatment of appendicitis. Compared with conventional laparoscopic appendectomy, the safety and efficacy of SILS-A is not known. This study clarified that SILS-A has a similar operation time in adults but needs more time in children, has similar complications, wound infection and length of the postoperative day in adults and children, and needs similar doses of narcotics in children.