SP3.1.13 Does Single-port laparoscopic appendicectomy provide better outcomes compared to conventional (three-ports) laparoscopic appendicectomy?

Aims To evaluate comparative outcomes of single port laparoscopic appendicectomy (SPLA) and conventional three-port laparoscopic appendicectomy (CLA) in the management of acute appendicitis. Methods A comprehensive systematic review of randomised controlled trials (RCTs) with subsequent meta-analysis of outcomes were conducted following PRISMA standards. Post-operative pain, cosmesis, need for an additional port(s), operative time, Post-operative complications, length of hospital stay(LOS), readmission, and reoperation were the evaluated outcome parameters. Results Sixteen RCTs reporting a total number of 2017 patients who underwent SPLA(n = 1009) or CLA(n = 1008) were included. SPLA showed higher cosmetic score (Mean Difference (MD) 1.11,P= 0.03) but significantly longer operative time (MD 7.08, P = 0.00001) compared to CLA. However, there was no significant difference between SPLA and CLA group in the postoperative pain score at 12 hours (MD -0.13,P=0.69), need for additional port(s) (Risk Ratio (RR)0.03, P = 0.07), postoperative ileus (RR 0.74,P=0.51), SSI ( RR 1.38, P = 0.28), Post-operative intra-abdominal collection (RR 0.00,P=0.62), LOS ( MD -2.41, P = 0.16), readmission to the hospital ( RR 0.45,P=0.22), and return to theatre (RR -0.00, P = 0.49). Subgroup analysis showed that operative time was comparable in adults only subgroup (P = 0.18) while it was significantly loner in paediatrics only subgroup(P = 0.00001). Moreover, LOS was shorter in adults only subgroup (P = 0.003) and no difference observed in paediatrics only subgroup (P = 0.93). Conclusion SPLA is associated with a slightly longer operative time; however, its efficacy and safety are comparable to CLA. Subgroup analysis showed that SPLA has better outcome in adults than paediatrics. Additionally, SPLA offers better post-operative cosmesis.