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WJOLS
WJOLS

10.5005/jp-journals-10033-1248
The Future of Suprapubic Single-incision Laparoscopic Appendectomy
SyStematic revieW

The Future of Suprapubic Single-incision Laparoscopic

Appendectomy

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1 Khaled Al-yaqout, Abdulaziz Alghurair, Hussain Al-Tarrah
ABSTRACT inTRoduCTion
Background: Suprapubic single-incision laparoscopic appen- From an era where open appendectomy was the gold
dectomy (SSILA) has recently been studied by different authors, standard management of acute appendicitis (AA),
the targeted benefits were better cosmesis, less infection and
possibly less hernia formation. emerged the three-port laparoscopic appendectomy
(TPLA) showing more promising results in regards to
Aim: To evaluate the feasibility and benefits of SSILA by revie-
wing the most recent data published to date, and identifying the postope rative pain, earlier return to work and cosmesis,
pros and cons of its use against an umbilical incision. and eventually proving to be a better predecessor. Sur-
Materials and methods: A systematic electronic search geons further challenged the three-port ideation with
based on preferred reporting items for systematic reviews and single-incision laparoscopic surgery (SILS), aiming for
meta-analyses (PRISMA) statement was conducted, articles even better cosmesis, and less postoperative pain. Single-
from 2010 to 2015 were reviewed. Only Adult population was
included in the study. Pre-, intra- and postoperative variables incision laparoscopic surgery was questioned by being
were included in our study, such as operative duration, wound more challenging, technically more difficult and can be
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infection, cosmetic outcome and pain. associated with more complications. A meta-analysis of
Results: Four studies were included and round up a total of 129 eight randomized controlled trials (RCTs), which included
patients. Incision size varied from 1.5 to 2.5 cm, procedure was 1234 patients, one compared TPLA to single-incision lapa-
completed in all studied candidates, mean operative time was roscopic appendectomy (SILA) for the management AA.
52.9 minutes, no intraoperative complications were recorded,
wound infection occurred in 0.015% of cases, mean hospital It showed similar outcomes in regards to both surgical
stay 1 to 4.7 days, pain and cosmetic outcome were difficult and medical complications, similar conversion rate,
to interpret due to the way, their evaluation was conducted. postoperative ileus, wound infection, re-operation rates,
Suprapubic single-incision laparoscopic appendectomy postoperative pain, hospital duration, and time to initiate
app ears to give a better operative view, follow-up duration 1 to
80 weeks. Most studies suffered from bias in all aspects. first meal. Although SILA seems to be superior in regards
to return to normal activity, and resumption of normal
Conclusion: Finding a different access site in acute appendi-
citis may decrease the rate of port-site complications, and diet. It still stands behind in regards to operative time by
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hence the morbidity associated with it. The suprapubic incision approximately 5 minutes. Starvros et al concluded that the
is an appealing alternative, with lack of strong evidence to sup- increased risk of hernia formation was not supported by
port it. The available evidence supports its use, but randomized any clinical evidence in their meta-analysis, but the follow-
controlled trials have to be conducted to determine its fait.
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up duration was reported to be short. Many authors
Keywords: Appendectomy, Laparoscopic, Single port, concluded that the umbilicus is the most common site for
Suprapubic.
port-site complications, it carries a greater risk of port-site
How to cite this article: Al-Yaqout K, Alghurair A, Al-Tarrah H. infection (PSI). This conclusions were evident in studies
The Future of Suprapubic Single-incision Laparoscopic
Appendectomy. World J Lap Surg 2015;8(2):57-61. investi gating SILS and conventional laparoscopy, done for
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various abdominal procedures. Not only the umbilicus
Source of support: Nil
flora augments this but also the fact that retrieving the
Conflict of interest: None appendix through the incision will further increase such
risk, and was linked to an increased incidence of hernia
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formation at those sites. The rationale of this review is
1-3 Registrar to evaluate the use of a suprapubic site of entry in SILA.
1 Department of General Surgery, Mubarak Al-Kabeer Our objective is to target adults presenting with AA. We
Hospital, Kuwait will evaluate it using the most recent evidence available.
2 Department of General Surgery, Al-Adan Hospital, Kuwait
MATeRiALS And MeTHodS
3 Department of General Surgery, Amiri Hospital, Kuwait
Literature Search
Corresponding Author: Khaled Al-Yaqout, Registrar
Department of General Surgery, Mubarak Al-Kabeer Hospital Our review followed the PRISMA statement. We con-
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Kuwait, Phone: +96597777609, e-mail: k.alyaqout@gmail.com
ducted a systematic electronic search using the following
World Journal of Laparoscopic Surgery, May-August 2015;8(2):57-61 57