Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Surgeon. 2021 Dec;19(6):365-379. doi: 10.1016/j.surge.2021.01.018. Epub 2021 Mar 19.
The aim of this systematic review and meta-analysis is to compare outcomes of single-port laparoscopic appendicectomy (SPLA) and conventional three-port laparoscopic appendicectomy (CLA) in the management of acute appendicitis.
A comprehensive systematic review of randomised controlled trials (RCTs) with subsequent meta-analysis and trial sequential analysis of outcomes were conducted. Post-operative pain at 12-h, cosmesis, need for an additional port(s), operative time, port-site hernia, ileus, surgical site infection (SSI), intra-abdominal collection, length of hospital stay (LOS), readmission, and reoperation were the evaluated outcome parameters.
Sixteen RCTs with total number of 2017 patients who underwent SPLA (n = 1009) or CLA (n = 1008) were included. SPLA was associated with a significantly higher cosmetic score (MD 1.11, P= 0.03) but significantly longer operative time (MD 7.08, P = 0.00001) compared to CLA. However, the difference was not significant between SPLA and CLA in the post-operative pain score at 12-h (MD -0.13, P = 0.69), need for additional port(s) (RR0.03, P = 0.07), port-site hernia (RD: 0.00, P = 0.68), 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). Trial sequential analysis demonstrated that the meta-analysis is conclusive for most of the outcomes, except LOS and intra-abdominal collection.
Although SPLA is associated with a slightly longer operative time, its efficacy and safety are comparable to CLA in management of uncomplicated appendicitis. Moreover, it offers improved post-operative cosmesis. The available evidence is conclusive, and further trials may not be required.
本系统评价和荟萃分析旨在比较单孔腹腔镜阑尾切除术（SPLA）和传统三孔腹腔镜阑尾切除术（CLA）治疗急性阑尾炎的效果。
对随机对照试验（RCT）进行全面系统评价，并随后进行荟萃分析和试验序贯分析。评估的结果参数包括术后 12 小时的疼痛、美容效果、是否需要额外的端口、手术时间、切口疝、肠梗阻、手术部位感染（SSI）、腹腔内积液、住院时间（LOS）、再入院和再次手术。
纳入了 16 项 RCT，共 2017 名接受 SPLA（n=1009）或 CLA（n=1008）治疗的患者。与 CLA 相比，SPLA 具有更高的美容评分（MD 1.11，P=0.03），但手术时间明显更长（MD 7.08，P=0.00001）。然而，SPLA 与 CLA 在术后 12 小时的疼痛评分（MD-0.13，P=0.69）、是否需要额外的端口（RR0.03，P=0.07）、切口疝（RD：0.00，P=0.68）、肠梗阻（RR 0.74，P=0.51）、SSI（RR 1.38，P=0.28）、术后腹腔内积液（RR 0.00，P=0.62）、LOS（MD-2.41，P=0.16）、再入院（RR 0.45，P=0.22）和再次手术（RR 0.00，P=0.49）方面差异无统计学意义。试验序贯分析表明，除 LOS 和腹腔内积液外，大多数结果的荟萃分析具有结论性。
尽管 SPLA 手术时间稍长，但在治疗单纯性阑尾炎方面，其疗效和安全性与 CLA 相当。此外，它还能提供更好的术后美容效果。现有证据具有结论性，可能不需要进一步的试验。
