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

Summary

Across 21 RCTs (n=2454), single-incision appendectomy had a nonsignificant 3.8-minute longer operative time versus three-port, a trend toward reduced time differences in recent years, similar pain scores at 12 and 24 hours, and comparable complications and conversion rates. Cosmetic satisfaction was higher with SILA, though 7% required an additional trocar.

Key Findings

• SILA averaged 3.80 minutes longer than CLA (MD 3.80; 95% CI −0.25 to 7.85; p=0.07).
• Meta-regression showed operative time differences decreased in more recent studies (p=0.003).
• CLA required fewer additional analgesics (SMD 0.24; 95% CI 0.10 to 0.38; p<0.01), but pain scores at 12 and 24 hours were not different.
• Postoperative complications and open conversion rates were similar between groups.
• Cosmetic satisfaction favored SILA; 7% of SILA cases required an additional trocar.

Clinical Implications

For patients prioritizing cosmetic outcomes, SILA can be offered with counseling about slightly longer operative time and a small chance of needing an extra port, while expecting similar pain and complication profiles to CLA.

Limitations

• Heterogeneity in analgesic protocols and outcome definitions across trials
• Limited long-term outcomes; cosmetic satisfaction measures may vary by study

Future Directions

Conduct contemporary RCTs with standardized analgesia and core outcome sets including validated cosmetic and patient-reported outcomes; evaluate hernia and port-site complications over longer follow-up.