Bayesian network meta‑analysis of the effects of single‑incision laparoscopic surgery, conventional laparoscopic appendectomy and open appendectomy for the treatment of acute appendicitis

Feng,Jian; Cui,Naiqiang; Wang,Zhenyu; Duan,Jutao

doi:10.3892/etm.2017.5343

Bayesian network meta‑analysis of the effects of single‑incision laparoscopic surgery, conventional laparoscopic appendectomy and open appendectomy for the treatment of acute appendicitis

Authors:
- Jian Feng
- Naiqiang Cui
- Zhenyu Wang
- Jutao Duan
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Affiliations: Department of Emergency, Tianjin Nankai Hospital, Tianjin 300100, P.R. China, Department of Hepatopancreatobiliary Surgery, Tianjin Nankai Hospital, Tianjin 300100, P.R. China, Department of Minimally Invasion Surgery, Tianjin Nankai Hospital, Tianjin 300100, P.R. China
Published online on: October 18, 2017 https://doi.org/10.3892/etm.2017.5343
Pages: 5908-5916
Copyright: © Feng et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present study aimed to systematically evaluate the effectiveness of single‑incision laparoscopic surgery (SILS), conventional laparoscopic appendectomy (CLA) and open appendectomy (OA) for the treatment of acute appendicitis. PubMed and Embase databases were systematically searched to identify relevant studies comparing the effectiveness of different appendectomy methods for treating acute appendicitis published prior to April 2016. ADDIS 1.16.5 software was used for data analysis. Heterogeneity was assessed using I2 statistic. Odds ratios or standardized mean differences and 95% confidence intervals were calculated and pooled accordingly. Consistency was assessed using node‑splitting analysis and inconsistency standard deviation. Convergence was assessed with the Brooks‑Gelman‑Rubin method using Potential Scale Reduction Factor (PSRF). Surgical procedure duration, duration of hospital stay, wound infection and incidence of abscesses were compared. A total of 24 eligible studies were included in this meta‑analysis. A consistency model was used to pool data regarding the four outcomes. The PSRFs in each item were all <1.03. Pooled results showed that, compared with OA, SILS and CLA were associated with significantly shorter durations of hospital stay (all P<0.01) and lower risk of wound infection (SILS vs. OA P=0.02 and CLA vs. OA P<0.01, respectively), but no significant differences were identified between SILS and CLA. However, compared with OA, SILS exhibited a significantly longer surgical procedure duration (P=0.01) and lower incidence of abscesses (P=0.04), while no significant difference was observed between OA and CLA. This comprehensive network meta‑analysis indicated that laparoscopic appendectomy, including SILS and CLA, may have more advantages for acute appendicitis compared with OA. Furthermore, SILS procedures require improvement and simplification to reduce the surgical procedure duration.

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1	Ruffolo C, Fiorot A, Pagura G, Antoniutti M, Massani M, Caratozzolo E, Bonariol L, di Pinto Calia F and Bassi N: Acute appendicitis: What is the gold standard of treatment? World J Gastroenterol. 19:8799–8807. 2013. View Article : Google Scholar : PubMed/NCBI
2	Cai YL, Xiong XZ, Wu SJ, Cheng Y, Lu J, Zhang J, Lin YX and Cheng NS: Single-incision laparoscopic appendectomy vs conventional laparoscopic appendectomy: Systematic review and meta-analysis. World J Gastroenterol. 19:5165–5173. 2013. View Article : Google Scholar : PubMed/NCBI
3	Sateesh S, Subraj H, Mahesh G and Rao PS: Comparative analysis between single incision and conventional laparoscopic appendectomy for acute appendicitis. Int J Res Med Sci. 2:1626–1631. 2014. View Article : Google Scholar
4	Minutolo V, Licciardello A, Di Stefano B, Arena M, Arena G and Antonacci V: Outcomes and cost analysis of laparoscopic versus open appendectomy for treatment of acute appendicitis: 4-years experience in a district hospital. BMC Surg. 14:142014. View Article : Google Scholar : PubMed/NCBI
5	Semm K: Endoscopic appendectomy. Endoscopy. 15:59–64. 1983. View Article : Google Scholar : PubMed/NCBI
6	Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG and Wei HB: Laparoscopic versus open appendectomy for acute appendicitis: A metaanalysis. Surg Endosc. 25:1199–1208. 2011. View Article : Google Scholar : PubMed/NCBI
7	Ingraham AM, Cohen ME, Bilimoria KY, Pritts TA, Ko CY and Esposito TJ: Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery. 148:625–637. 2010. View Article : Google Scholar : PubMed/NCBI
8	Cugura JF, Janković J, Kulis T, Kirac I and Beslin MB: Single incision laparoscopic surgery (SILS) cholecystectomy: Where are we? Acta Clin Croat. 47:245–248. 2008.PubMed/NCBI
9	Frutos MD, Abrisqueta J, Lujan J, Abellan I and Parrilla P: Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg. 257:413–418. 2013. View Article : Google Scholar : PubMed/NCBI
10	Lee WS, Choi ST, Lee JN, Kim KK, Park YH, Lee WK, Baek JH and Lee TH: Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: A prospective randomized controlled study. Ann Surg. 257:214–218. 2013. View Article : Google Scholar : PubMed/NCBI
11	Higgins JP and Green S: Cochrane Handbook For Systematic Reviews Of Interventions. Wiley Online Library; 2008, View Article : Google Scholar
12	Hillege H, de Brock B, van Valkenhoef G and Zhao J: ADDIS: An automated way to do network meta-analysis. University of Groningen, Research Institute SOM (Systems, Organisations and Management). 2012.
13	Valkenhoef G, Tervonen T, Zwinkels T, Brock B and Hillege H: ADDIS: A decision support system for evidence-based medicine. Decis Support Syst. 55:459–475. 2013. View Article : Google Scholar
14	Lau J, Ioannidis JP and Schmid CH: Quantitative synthesis in systematic reviews. Ann Intern Med. 127:820–826. 1997. View Article : Google Scholar : PubMed/NCBI
15	Feng RN, Zhao C, Sun CH and Li Y: Meta-analysis of TNF 308 G/A polymorphism and type 2 diabetes mellitus. PLoS One. 6:e184802011. View Article : Google Scholar : PubMed/NCBI
16	Lu G and Ades A: Assessing evidence inconsistency in mixed treatment comparisons. J Am Stat Assoc. 101:447–459. 2006. View Article : Google Scholar
17	Dias S, Welton NJ, Caldwell DM and Ades AE: Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 29:932–944. 2010. View Article : Google Scholar : PubMed/NCBI
18	Brooks SP and Gelman A: General methods for monitoring convergence of iterative simulations. J Comput Graphical Stat. 7:434–455. 1998. View Article : Google Scholar
19	Carter JT, Kaplan JA, Nguyen JN, Lin MY, Rogers SJ and Harris HW: A prospective, randomized controlled trial of single-incision laparoscopic vs conventional 3-port laparoscopic appendectomy for treatment of acute appendicitis. J Am Coll Surg. 218:950–959. 2014. View Article : Google Scholar : PubMed/NCBI
20	Cipe G, Idiz O, Hasbahceci M, Bozkurt S, Kadioglu H, Coskun H, Karatepe O and Muslumanoglu M: Laparoscopic versus open appendectomy: Where are we now? Chirurgia (Bucur). 109:518–522. 2014.PubMed/NCBI
21	Clarke T, Katkhouda N, Mason RJ, Cheng BC, Olasky J, Sohn HJ, Moazzez A, Algra J, Chaghouri E and Berne TV: Laparoscopic versus open appendectomy for the obese patient: A subset analysis from a prospective, randomized, double-blind study. Surg Endosc. 25:1276–1280. 2011. View Article : Google Scholar : PubMed/NCBI
22	Ignacio RC, Burke R, Spencer D, Bissell C, Dorsainvil C and Lucha PA: Laparoscopic versus open appendectomy: What is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc. 18:334–337. 2004. View Article : Google Scholar : PubMed/NCBI
23	Jategaonkar PA and Yadav SP: Single site multiport umbilical laparoscopic appendicectomy versus conventional multiport laparoscopic appendicectomy in acute settings. Ann R Coll Surg Engl. 96:452–457. 2014. View Article : Google Scholar : PubMed/NCBI
24	Jiang X, Meng HB, Zhou DL, Ding WX and Lu LS: Comparison of clinical outcomes of open, laparoscopic and single port appendicectomies. Ann R Coll Surg Engl. 95:468–472. 2013. View Article : Google Scholar : PubMed/NCBI
25	Katkhouda N, Mason RJ and Towfigh S: Laparoscopic versus open appendectomy: A prospective, randomized, double-blind study. Adv Surg. 40:1–19. 2006. View Article : Google Scholar : PubMed/NCBI
26	Kocataş A, Gönenç M, Bozkurt MA, Karabulut M, Gemici M and Alış H: Comparison of open and laparoscopic appendectomy in uncomplicated appendicitis: A prospective randomized clinical trial. Ulus Travma Acil Cerrahi Derg. 19:200–204. 2013. View Article : Google Scholar : PubMed/NCBI
27	Kye BH, Lee J, Kim W, Kim D and Lee D: Comparative study between single-incision and three-port laparoscopic appendectomy: A prospective randomized trial. J Laparoendosc Adv Surg Tech A. 23:431–436. 2013. View Article : Google Scholar : PubMed/NCBI
28	Moberg AC, Berndsen F, Palmquist I, Petersson U, Resch T and Montgomery A: Randomized clinical trial of laparoscopic versus open appendicectomy for confirmed appendicitis. Br J Surg. 92:298–304. 2005. View Article : Google Scholar : PubMed/NCBI
29	Mori Villalobos R, Rufino Escoll J, Herrerías González F, Mias Carballal MC, Escartin Arias A and Olsina Kissler JJ: Prospective, randomized comparative study between single-port laparoscopic appendectomy and conventional laparoscopic appendectomy. Cir Esp. 92:472–477. 2014.(In English, Spanish). PubMed/NCBI
30	Pan Z, Jiang XH, Zhou JH and Ji ZL: Transumbilical single-incision laparoscopic appendectomy using conventional instruments: The single working channel technique. Surg Laparosc Endosc Percutan Tech. 23:208–211. 2013. View Article : Google Scholar : PubMed/NCBI
31	Park J, Kwak H, Kim SG and Lee S: Single-port laparoscopic appendectomy: Comparison with conventional laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A. 22:142–145. 2012. View Article : Google Scholar : PubMed/NCBI
32	Park JH, Hyun KH, Park CH, Choi SY, Choi WH, Kim DJ, Lee S and Kim JS: Laparoscopic vs transumbilical single-port laparoscopic appendectomy; results of prospective randomized trial. J Korean Surg Soc. 78:213–218. 2010. View Article : Google Scholar
33	Pedersen AG, Petersen O, Wara P, Rønning H, Qvist N and Laurberg S: Randomized clinical trial of laparoscopic versus open appendicectomy. Br J Surg. 88:200–205. 2001. View Article : Google Scholar : PubMed/NCBI
34	Quezada F, Quezada N, Mejia R, Brañes A, Padilla O, Jarufe N and Pimentel F: Laparoscopic versus open approach in the management of appendicitis complicated exclusively with peritonitis: A single center experience. Int J Surg. 13:80–83. 2015. View Article : Google Scholar : PubMed/NCBI
35	Ricca R, Schneider JJ, Brar H and Lucha PA: Laparoscopic appendectomy in patients with a body mass index of 25 or greater: Results of a double blind, prospective, randomized trial. JSLS. 11:54–58. 2007.PubMed/NCBI
36	Sozutek A, Colak T, Dirlik M, Ocal K, Turkmenoglu O and Dag A: A prospective randomized comparison of single-port laparoscopic procedure with open and standard 3-port laparoscopic procedures in the treatment of acute appendicitis. Surg Laparosc Endosc Percutan Tech. 23:74–78. 2013. View Article : Google Scholar : PubMed/NCBI
37	Teoh AY, Chiu PW, Wong TC, Poon MC, Wong SK, Leong HT, Lai PB and Ng EK: A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy. Ann Surg. 256:909–914. 2012. View Article : Google Scholar : PubMed/NCBI
38	Tzovaras G, Baloyiannis I, Kouritas V, Symeonidis D, Spyridakis M, Poultsidi A, Tepetes K and Zacharoulis D: Laparoscopic versus open appendectomy in men: A prospective randomized trial. Surg Endosc. 24:2987–2992. 2010. View Article : Google Scholar : PubMed/NCBI
39	Wu SC, Wang YC, Fu CY, Chen RJ, Huang HC, Huang JC, Lu CW, Hsieh CH and Lin CY: Laparoscopic appendectomy provides better outcomes than open appendectomy in elderly patients. Am Surg. 77:466–470. 2011.PubMed/NCBI
40	Cox MR, McCall JL, Toouli J, Padbury RT, Wilson TG, Wattchow DA and Langcake M: Prospective randomized comparison of open versus laparoscopic appendectomy in men. World J Surg. 20:263–266. 1996. View Article : Google Scholar : PubMed/NCBI
41	Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K and Hirakawa K: Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis. J Gastrointest Surg. 16:1929–1939. 2012. View Article : Google Scholar : PubMed/NCBI
42	Huang YJ, Chen QJ and Xu LC: Laparoscopic treatment of appendix root perforation complicated with acute suppurative peritonitis. J Huaihai Med. 3:0062013.
43	Corneille MG, Steigelman MB, Myers JG, Jundt J, Dent DL, Lopez PP, Cohn SM and Stewart RM: Laparoscopic appendectomy is superior to open appendectomy in obese patients. Am J Surg. 194:877–881. 2007. View Article : Google Scholar : PubMed/NCBI
44	Gill RS, Shi X, Al-Adra DP, Birch DW and Karmali S: Single-incision appendectomy is comparable to conventional laparoscopic appendectomy: A systematic review and pooled analysis. Surg Laparosc Endosc Percutan Tech. 22:319–327. 2012. View Article : Google Scholar : PubMed/NCBI
45	Saber AA, Elgamal MH, El-Ghazaly TH, Dewoolkar AV and Akl A: Simple technique for single incision transumbilical laparoscopic appendectomy. Int J Surg. 8:128–130. 2010. View Article : Google Scholar : PubMed/NCBI
46	Hua J, Gong J, Xu B, Yang T and Song Z: Single-incision versus conventional laparoscopic appendectomy: A meta-analysis of randomized controlled trials. J Gastrointest Surg. 18:426–436. 2014. View Article : Google Scholar : PubMed/NCBI
47	Switzer NJ, Gill RS and Karmali S: The evolution of the appendectomy: From open to laparoscopic to single incision. Scientifica (Cairo). 2012:8954692012.PubMed/NCBI
48	Wilms IM, de Hoog DE, de Visser DC and Janzing HM: Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev: CD008359. 2011. View Article : Google Scholar