Page 26 - Laparoscopic Journal - WJOLS

Khaled Al-yaqout et al
keywords in every possible combination ‘wound’ ‘lapa- A systematic research revealed 46 articles, the search was
roscopic’ ‘single’ ‘port’ ‘access’ ‘complications’ ‘infection’ restricted to adults (age ≥ 19 years), and studies conducted
‘SILS’ ‘LESS’ ‘incision’ ‘appendectomy’ ‘site’ ‘suprapubic’ in the past 5 years only. We have initially restricted the
‘SPL’ ‘single port appendectomy (SPA)’ ‘one port umbilical search to RCTs but were not able to obtain any results
surgery (OPUS)’ ‘natural orifice transumbilical surgery matching our inclusion criteria, hence the highest level
(NOTUS)’ ‘SILA’. Search engines used: Medical litera- of evidence available was used. From 46 articles, 12 were
ture analysis and retrieval system online (MEDLINE), filtered by title. Eventually, nine articles were reviewed
Excerpta medica dataBASE (EMBASE), chochrane library. after exclusion by abstracts. Out of nine full texts only
Relevant articles in the studies collected were also evalu- four studies were included in our review. One study was
9
ated. Last search was done on 24/8/2015. excluded due to small sample size. Exclusion was based
nine on our inclusion and exclusion criteria. The articles
inclusion Criteria
characteristics are presented in Table 1 and patient charac -
Studies focusing on port-site complication, specially those teristics and outcomes in Table 2.
comparing rate of infection at different incision sites. In
addition, we included papers evaluating the applicabi lity Type of Studies and Bias
of SILA. The search results were limited to systematic All four studies were conducted on adults diagnosed with
reviews, meta-analysis and randomized controlled trials AA, none of them was an RCT. Only one study included
(RCT), once not available the best available evidence was those with complicated AA. Pooled sample size for all
7
included. Search results were filtered initially by scree­ studies was 129 patients. The studies were published
ning the article titles, once approved by the two authors between 2011 and 2015. The article type varied, Vidal et al
abstracts were further screened, at this stage the full conducted a prospective study, Ze Zhang et al got their
10
articles were retrieved and decided to be included or not, results through a propensity matched analysis, a retro-
7
if at any stage there was a disagreement on the inclusion spective study was conducted by Wang Y et al, and a
11
or exclusion the third author acted as a referee. case series was presented by Alvarez et al. 12
exclusion Criteria The sample size ranged from 15 to 54 patients. All
studies suffered from selection bias. There was no ran-
Studies conducted on pediatrics population, obstetric and dom sequence in selecting the candidates, except for
gynecology procedure, urological procedures, cases of Ze Zhang et al who were trying to eliminate bias by
7
malignancy and robotic surgery procedures. One study using propensity matched analysis. No evidence of
was excluded due to small sample size. concealment was present when selecting the study can-
Funding didates in all papers, so, in conclusion selection bias is
profound along most of the articles. Both participants
There was no funding for this review, all articles were and candidates were aware of the type of procedure
obtained through individual university access. being performed. Blinding was not evident even in
the assessment of variable outcomes, such as postope-
ReSuLTS
rative complications and wound cosmesis. Hence, per-
formance and detection bias is also profound along all
studies. All papers suffered attrition bias, by excluding
the complicated appendixes in three articles, 10-12 or by
excluding those who did not have a matching population
without mentioning the outcome of them. 7

Surgical Technical Aspects
All procedures were performed under GA where there
was no contraindication to laparoscopic surgery. All
surgeries were performed by surgeons experienced in
laparoscopic surgery. Wound size was 1.5 cm on two
7
10
studies, 11,12 2 cm and 2.5 cm. Two authors used a self
10
made port. 7,11 One conducted the study using SILS port,
12
and one using R-port. The operative time range was
[(35–76.36 minutes) (mean = 52.91 minutes)]. None of the
studies reported any intraoperative complication, use
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