Systematic review and meta-analysis of single-incision versus conventional laparoscopic appendectomy in children

Zhang, Ze; Wang, Yanan; Liu, Ruoyan; Zhao, Liying; Líu, Hao; Zhang, Jianming; Li, Guoxin

doi:10.1016/j.jpedsurg.2015.05.018

Cited by 32 publications

(13 citation statements)

References 41 publications

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“…In the large meta-analysis by Zhang et al, no significant differences were observed between SILA and CLA with respect to the incidence of total postoperative complications, IAA, ileus, wound hematoma, length of hospital stay, or the frequency of use of additional analgesics. However, SILA was associated with a higher incidence of SSI compared with three-port LA and required a longer operative time [147].…”

Section: Q44: Does Laparoscopic Single-incision Surgery Confer Any mentioning

confidence: 89%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Section: Q44: Does Laparoscopic Single-incision Surgery Confer Any mentioning

confidence: 89%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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“…Comparative financial studies have shown SIPES to be equivalent in cost to multiport approaches for common pediatric surgical diseases [2,44,67]. Assessments of both costs from operative time, as well as costs of operative tools, show equivalency over these disease states, with other studies showing equivalent hospital lengths of stay, returns, and complications [2,44,57,67,68]. Initial increased costs for single-incision approaches reported in literature have been minimized with the advent of standard reusable laparoscopic instruments [67,68].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, typical pediatric incisions are naturally smaller than adult equivalents. Increasingly, larger comparisons over patients with single versus multiport approaches over appendectomies have shown perioperative outcomes of pain are noninferior to decreased in single site approaches, though the degree of significance in some studies is as small as a single analgesic dose, which again may not be as significant clinically [57,58,59]. Despite possible perceptions to the contrary, the possible superiority offered by SIPES especially regarding pain and cosmesis, in the setting of otherwise proven equivalence of morbidity rates in the pediatric literature, may be reason for favoring a SIPES approach compared to a multiport equivalent.…”

Section: Discussionmentioning

confidence: 99%

Single Incision Pediatric Endoscopic Surgery: From Myth to Reality a Case Series

2019

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Laparoscopic surgery has continued to evolve to minimize access sites and scars in both the adult and pediatric populations. In children, single-incision pediatric endoscopic surgery (SIPES) has been shown to be effective, feasible, and safe with comparative results to multiport equivalents. Thus, the use of SIPES continues over increasingly complex cases, however, conceptions of its efficacy continue to vary greatly. In the present case series and discussion, we review the history of SIPES techniques and its current application today. We present this in the setting of five common myths about SIPES techniques: limitations against complex cases, restrictions to specialized training, increased morbidity outcomes, increased operative lengths, and increased operative costs. Regarding the myth of SIPES being limited in application to simple cases, examples were highlighted throughout the literature in addition to the authors’ own experience with three complex cases including resection of a lymphatic malformation, splenectomy with cholecystectomy, and distal pancreatectomy with splenectomy. A review of SIPES learning curves shows equivalent operative outcomes to multiport learning curves and advancements towards practical workshops to increase trainee familiarity can help assuage these aptitudes. In assessing comorbidities, adult literature reveals a slight increase in incisional hernia rates, but this does not correlate with single-incision pediatric data. In experienced hands, operative SIPES times average approximate multiport laparoscopic equivalents. Finally, regarding expenses, SIPES represents an equivalent alternative to laparoscopic techniques.

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“…The technique of SILS has been developed in paediatric surgery. Successful experiences have been reported in several operations such as inguinal hernia repair, varicocelectomy and appendicectomy . Although some reports have suggested that SILS is associated with less surgical trauma, better cosmesis and less postoperative pain, it has also been criticized for the lack of triangulation and crowding of instruments .…”

Section: Discussionmentioning

confidence: 99%

“…Successful experiences have been reported in several operations such as inguinal hernia repair, varicocelectomy and appendicectomy. [11][12][13] Although some reports have suggested that SILS is associated with less surgical trauma, better cosmesis and less postoperative pain, it has also been criticized for the lack of triangulation and crowding of instruments. 14 Despite the lack of large-scaled studies on LG in children, we started to perform this operation in 2012, given the initial experience gained from the other procedures.…”

Section: Discussionmentioning

confidence: 99%

Comparing single‐incision versus standard laparoscopic gastrostomy in paediatric patients

2017

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Aim The aim of the present study was to evaluate the outcomes of single‐incision laparoscopic gastrostomy (SILG) compared with standard laparoscopic gastrostomy (LG). Patients and Methods Paediatric patients (age <18 years) with gastrostomy placement (+/−concomitant fundoplication) in the past 3 years were reviewed. Demographic data and intraoperative and postoperative events were compared. Results Thirty‐eight patients were identified (LG : SILG = 25:13). There were no significant differences between (LG vs SILG) age (5.7 vs 4.2 years, P = 0.45) and body weight at operation (15.3 vs 12.4 kg, P = 0.36). The median operative durations for the LG and SILG groups were 38 versus 45 min, respectively (P = 0.21). There was one major complication in the LG group, but none was reported in the SILG group. Seven patients (28 per cent) in the LG group suffered from minor complications compared to two (15.4 per cent) in the SILG group (P = 0.8). Gastrostomy feeding was initiated on postoperative day 1 the in majority of patients in both groups (LG: 92 per cent vs SILG: 100 per cent, P = 0.18). Conclusion SILG is technically feasible in paediatric patients, and outcomes were comparable to LG in the present study. This approach should be considered when concomitant procedure is not required in order to minimize the number of surgical wounds.

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Systematic review and meta-analysis of single-incision versus conventional laparoscopic appendectomy in children

Cited by 32 publications

References 41 publications

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Single Incision Pediatric Endoscopic Surgery: From Myth to Reality a Case Series

Comparing single‐incision versus standard laparoscopic gastrostomy in paediatric patients

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