Single-port laparoscopic appendicectomy versus conventional three-port approach for acute appendicitis in children: a sy
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ORIGINAL ARTICLE
Single‑port laparoscopic appendicectomy versus conventional three‑port approach for acute appendicitis in children: a systematic review and meta‑analysis Shafquat Zaman1 · Ali Yasen Y. Mohamedahmed1 · Stephen Stonelake1 · Ananth Srinivasan1 · Abdul Karim Sillah1 · Shahab Hajibandeh2 · Shahin Hajibandeh1 Accepted: 22 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aim To evaluate comparative outcomes of single-port laparoscopic appendicectomy (SPLA) and conventional three-port laparoscopic appendicectomy (CLA) in the management of acute appendicitis in children. Methods A comprehensive systematic review of randomised controlled trials (RCTs) with subsequent meta-analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. Operative time, surgical site infection, intra-abdominal collection, incisional hernia, length of hospital stay (LOS), additional port/s and conversion to open were the evaluated outcome parameters. Results Four RCTs reporting a total number of 520 patients who underwent SPLA (n = 260) or CLA (n = 260) were included. There was no difference between SPLA and CLA group in post-operative collection (risk difference (RD) − 0.00, P = 0.94), surgical site infection (RD 0.02, P = 0.25), incisional hernia (RD 0.00 P = 1), LOS (mean difference (MD) 0.73 P = 0.93), need for additional port/s (RD 0.04, P = 0.24) and conversion to open (RD 0.00, P = 1). However, there was a significantly longer operative time in the SPLA group (MD 9.80, P = 0.00001). The certainty of the evidence was judged to be moderate for all outcomes. Conclusions SPLA and CLA seem to have comparable efficacy and safety in children with acute appendicitis although the former may be associated with longer procedure time. Future high-quality RCTs with adequate sample sizes are required to provide stronger evidence in favour of an intervention. Keywords Appendicectomy · Single port · Laparoscopic surgery
Introduction
Shafquat Zaman, Ali Yasen Y. Mohamedahmed and Stephen Stonelake had an equal contribution in this study proposing joint first authorship. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00383-020-04776-z) contains supplementary material, which is available to authorized users. * Ali Yasen Y. Mohamedahmed [email protected] 1
Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK
2
Acute appendicitis is the most common abdominal emergency presenting to paediatric and adult surgical units worldwide with 8% lifetime risk [1]. To prevent appendicular perforation and abdominal or pelvic sepsis sequelae, open or laparoscopic appendicectomy remains the mainstay of management [2, 3]. Although antibiotic therapy may be suitable in selected cases, recurrence rates, and the need for subsequent surgical intervention can be as h
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