Currently there is no evidence available from randomised control trials to determine whether Single Incision Laparoscopic Surgery provides any better effect than Conventional Multi-incision Laparoscopic Surgery for appendicectomy.

Rehman H, Rao AM, Ahmed I

Published Online:

July 6, 2011

Laparoscopic appendicectomy is used in treating appendicitis and can be achieved using several skin incisions in the abdominal wall, or more recently with a single skin incision through which instruments are introduced into the peritoneal cavity. Since no randomised control trials of single incision versus conventional multi-incision laparoscopic surgery for appendicectomy could be found, the efficacy and safety of the two approaches could not be analysed in this review. There is a need for randomised control trials of single incision laparoscopic appendicectomy for appendicitis.

Abstract (click to read)

Background:

Appendicectomy is a well established surgical procedure used in the management of acute appendicitis. The operation can be performed with minimally invasive surgery (laparoscopic) or as an open procedure. A recent development in appendicectomy has been the introduction of less invasive single incision laparoscopic surgery, using a single multi-luminal port or multiple mono-luminal ports, through a single skin incision. There are yet unanswered questions regarding the efficacy of this new and novel technique including: patient benefit and satisfaction, complications, long-term outcomes, and survival.

Objectives:

The aim of this review is to perform meta-analysis using data from available trials comparing single incision with conventional multi-incision laparoscopic appendicectomy for appendicitis, in order to ascertain any differences in outcome.

Search strategy:

We searched the electronic databases including MEDLINE/PubMed (from 1980 to December 2010), EMBASE/Ovid (from 1980 to December 2010) and CENTRAL (The Cochrane Library 2010, Issue 11) with pre-specified terms. We also searched reference lists of relevant articles and reviews, conference proceedings and ongoing trial databases.

Selection criteria:

Randomised or quasi-randomised controlled trials of patients with appendicitis, or symptoms of appendicitis, undergoing laparoscopic appendicectomy, in which at least one arm involves single incision procedures and another multi-incision procedures.

Data collection and analysis:

There were no RCTs or prospectively controlled trials found that met the inclusion criteria.

Main results:

Three authors performed study selection independently.

No studies that met the inclusion criteria of this review were identified. Current evidence exists only the form of case-series.

This review has been authored as 'empty' pending the results of 5 ongoing trials.

Authors' conclusions:

No RCTs comparing single incision laparoscopic appendectomy with multi-incision surgery could be identified. No definitive conclusions can be made at this time. Well designed prospective RCTs are required in order to evaluate benefit or harm from laparoscopic surgical approaches for appendicectomy. Until appropriate data has been reported, the institutional polices of healthcare providers must be based on the clinical judgement of experts in the field.

This record should be cited as:

Rehman H, Rao AM, Ahmed I. Single incision versus conventional multi-incision appendicectomy for suspected appendicitis. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD009022. DOI: 10.1002/14651858.CD009022.pub2

Assessed as up to date:

February 1, 2011

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Primary Review Group:

Colorectal Cancer Group

Health topics:

Gastroenterology > Non-neoplastic disease of the small & large bowel > Appendiceal diseases

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Currently there is no evidence available from randomised control trials to determine whether Single Incision Laparoscopic Surgery provides any better effect than Conventional Multi-incision Laparoscopic Surgery for appendicectomy.

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