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Single‐incision versus conventional three‐incision laparoscopic appendectomy: A meta‐analysis of randomized controlled trials
Author(s) -
Deng Lihui,
Xiong Junjie,
Xia Qing
Publication year - 2017
Publication title -
journal of evidence‐based medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.885
H-Index - 22
ISSN - 1756-5391
DOI - 10.1111/jebm.12238
Subject(s) - medicine , cosmesis , randomized controlled trial , surgery , confidence interval , odds ratio , acute appendicitis , meta analysis , appendicitis , laparoscopy , anesthesia
Background Conventional three‐incision laparoscopic appendectomy (CTLA) is considered the new golden standard for the treatment of acute appendicitis. However, single‐incision laparoscopic appendectomy (SILA) can further reduce the number of abdominal incisions and visible scars. Methods Major databases were researched for randomized clinical trials (RCTs) comparing SILA and CTLA for acute appendicitis from January 1983 and to March 2015. The technical feasibility, effectiveness, and safety between SILA and CTLA were compared. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed‐ or random‐effects models. Results In total, 11 RCTs with 1489 patients were analyzed. The patients in the SILA group had a significantly shorter hospital duration (WMD: –0.63; 95% CI: –1.04, –0.21; P = 0.003) and return to activity (WMD: –2.91; 95% CI: –5.45, –0.37; P = 0.02) but experienced a longer operating time (WMD: 6.56; 95% CI: 3.55, 9.58; P < 0.0001) and higher rate of conversion (OR: 6.82; 95% CI: 3.14, 14.79; P < 0.00001). There were no differences between the two groups in visual analog pain scores, doses of analgesics, overall complication rates, wound infection, or cosmesis (all P > 0.05). Conclusions SILA is a safer and more effective than CTLA in both pediatric and adult patients.