Gill Richdeep S, Shi Xinzhe, Al-Adra David P, Birch Daniel W, Karmali Shahzeer
Department of Surgery, University of Alberta, Edmonton, AB Canada.
Surg Laparosc Endosc Percutan Tech. 2012 Aug;22(4):319-27. doi: 10.1097/SLE.0b013e31824f2cf8.
Acute appendicitis remains the common gastrointestinal emergency in adults. Single-incision laparoscopic appendectomy (SILA) has been proposed as the next evolution in minimally invasive surgery. SILA is postulated to reduce postoperative pain and enhance cosmesis, while effectively removing an inflamed appendix. However, the efficacy and benefits of SILA compared with conventional laparoscopic appendectomy (CLA) remain to be determined. Our objectives were to systematically review the literature comparing SILA with CLA for acute appendicitis and perform a pooled analysis on the efficacy of SILA.
Published English-language manuscripts were considered for review inclusion. A comprehensive search of electronic databases (eg, MEDLINE, EMBASE, SCOPUS, BIOSIS Previews, and the Cochrane Library) using broad search terms was completed. All comparative studies were included if they incorporated adult patients undergoing appendectomy for acute appendicitis by SILA. The primary outcomes of interest were operative time and length of hospital stay.
From a total of 366 articles, 34 articles were identified. A total of 9 comparative studies were included for pooled analysis. There was no significant difference in operative time, length of stay, pain scores, and conversion or complication rates between SILA and CLA for acute appendicitis.
This systematic review and pooled analysis demonstrates that SILA is comparable to CLA for acute appendicitis in adults. However, this review identifies the need for randomized controlled trials to clarify the efficacy of SILA compared with CLA.
急性阑尾炎仍是成人常见的胃肠道急症。单切口腹腔镜阑尾切除术（SILA）被认为是微创手术的下一步发展。SILA被假定可减轻术后疼痛并改善美观，同时有效切除发炎的阑尾。然而，与传统腹腔镜阑尾切除术（CLA）相比，SILA的疗效和益处仍有待确定。我们的目标是系统回顾比较SILA与CLA治疗急性阑尾炎的文献，并对SILA的疗效进行汇总分析。
考虑纳入已发表的英文手稿进行综述。使用广泛的搜索词对电子数据库（如MEDLINE、EMBASE、SCOPUS、BIOSIS Previews和Cochrane图书馆）进行了全面搜索。如果比较研究纳入了接受SILA治疗急性阑尾炎的成年患者，则全部纳入。感兴趣的主要结局是手术时间和住院时间。
从总共366篇文章中，筛选出34篇文章。总共纳入9项比较研究进行汇总分析。对于急性阑尾炎，SILA与CLA在手术时间、住院时间、疼痛评分以及中转或并发症发生率方面没有显著差异。
这项系统综述和汇总分析表明，SILA在治疗成人急性阑尾炎方面与CLA相当。然而，本综述指出需要进行随机对照试验以阐明SILA与CLA相比的疗效。
