BACKGROUND: Single incision laparoscopic surgery (SILS) has been proposed as the next step in minimally invasive surgery for appendicectomy. Previous reviews have summarised the results of low evidence comparative studies suggest that the two approaches are comparable in terms of outcomes, but have proven the need for randomised controlled trials (RCTs). This review meta-analyses RCTs on this topic to evaluate the safety and efficacy of single incision laparoscopic appendectomy (SILA). METHODS: A comprehensive research of electronic databases has been performed. Primary outcomes (overall and access-specific morbidity) were designed as safety issues. Secondary outcomes were pain, cosmesis, operative time, conversion rate and length of hospital stay. RESULTS: FOLLOWING EXCLUSIONS, 5 RCTS SATISFIED THE INCLUSION CRITERIA, INCLUDING A TOTAL OF: 761 patients (379 SILA and 382 conventional three-port laparoscopic appendectomies - CLA). No significant differences in overall morbidity, early wound morbidity or length of stay were found between SILA and conventional three-port laparoscopic appendectomy (CLA). Cosmesis and pain were not comparable due to different scales and time records. Conclusions on incisional hernia rate were not reliable due to short follow-up periods. CONCLUSIONS: SILA can be considered an acceptable alternative to CLA in the treatment of acute appendicitis,but an economic evaluation of the various techniques for single access must be performed before its widespread clinical introduction. Better designed RCTs are necessary to define a population in which SILA could have major benefits. This article is protected by copyright. All rights reserved.

Acute appendicitis can be treated with single incision laparoscopy: a systematic review of randomized controlled trials

MORINO, Mario
Last
2015-01-01

Abstract

BACKGROUND: Single incision laparoscopic surgery (SILS) has been proposed as the next step in minimally invasive surgery for appendicectomy. Previous reviews have summarised the results of low evidence comparative studies suggest that the two approaches are comparable in terms of outcomes, but have proven the need for randomised controlled trials (RCTs). This review meta-analyses RCTs on this topic to evaluate the safety and efficacy of single incision laparoscopic appendectomy (SILA). METHODS: A comprehensive research of electronic databases has been performed. Primary outcomes (overall and access-specific morbidity) were designed as safety issues. Secondary outcomes were pain, cosmesis, operative time, conversion rate and length of hospital stay. RESULTS: FOLLOWING EXCLUSIONS, 5 RCTS SATISFIED THE INCLUSION CRITERIA, INCLUDING A TOTAL OF: 761 patients (379 SILA and 382 conventional three-port laparoscopic appendectomies - CLA). No significant differences in overall morbidity, early wound morbidity or length of stay were found between SILA and conventional three-port laparoscopic appendectomy (CLA). Cosmesis and pain were not comparable due to different scales and time records. Conclusions on incisional hernia rate were not reliable due to short follow-up periods. CONCLUSIONS: SILA can be considered an acceptable alternative to CLA in the treatment of acute appendicitis,but an economic evaluation of the various techniques for single access must be performed before its widespread clinical introduction. Better designed RCTs are necessary to define a population in which SILA could have major benefits. This article is protected by copyright. All rights reserved.
17
4
281
289
Appendicitis, Laparoscopy, Single site surgery
N. Vettoretto;R. Cirocchi;J. Randolph;M. Morino
File in questo prodotto:
File Dimensione Formato  
acute appendicitis_4aperto.pdf

Open Access dal 01/08/2016

Tipo di file: POSTPRINT (VERSIONE FINALE DELL’AUTORE)
Dimensione 493.69 kB
Formato Adobe PDF
493.69 kB Adobe PDF Visualizza/Apri
codi12839.pdf

Accesso riservato

Tipo di file: PDF EDITORIALE
Dimensione 395.3 kB
Formato Adobe PDF
395.3 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/155811
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 18
  • ???jsp.display-item.citation.isi??? 19
social impact