Meta-analysis of single-incision versus three-port laparoscopic appendectomy comparing operation time and postoperative pain

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BACKGROUND: Unresolved debates persist regarding operative time and postoperative pain when comparing single-incision laparoscopic appendectomy (SILA) with three-port conventional laparoscopic appendectomy (CLA) for acute appendicitis. To address these issues, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing the clinical outcomes of SILA and CLA. METHODS: An electronic search was performed using PubMed, Embase and the Cochrane Central Register of Controlled Trials through January 2025. The primary outcomes were operative time and postoperative pain, while secondary outcomes included the incidence of postoperative complications, additional trocar requirements, open conversion rate, and cosmetic satisfaction. A meta-regression was conducted to assess the relationship between surgical outcomes and the era in which the surgery was performed. RESULTS: After excluding four RCTs because of a high risk of bias in the randomization process, a total of 21 RCTs encompassing 2454 patients were included. The pooled analysis showed that SILA required an average of 3.80 min longer than CLA (mean difference [MD] = 3.80 min, 95% confidence interval [CI]: -0.25 to 7.85; P = 0.07). However, meta-regression of studies arranged by initiation year revealed a significant trend toward a decreased MD with more recent surgeries ( P = 0.003). Although the CLA group required fewer additional analgesics (standardized mean difference [SMD] = 0.24, 95% CI: 0.10 to 0.38, P < 0.01), no significant differences were found in pain scores at 12 h (MD = -0.04, 95% CI: -0.72 to 0.63, P = 0.91) or 24 h (MD = 0.08, 95% CI: -0.30 to 0.46, P = 0.67). Furthermore, while postoperative complications and open conversion rates were similar between groups, the SILA group reported higher cosmetic satisfaction. Additional trocars were inserted in 60 of 932 SILA cases (weighted proportion = 0.07, 95% CI: 0.05 to 0.10). CONCLUSION: Given the diminishing difference in operative time and manageable postoperative pain compared with CLA, SILA may be considered a viable alternative for the treatment of acute appendicitis, particularly in selected patients for whom cosmetic outcomes are a priority.

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