Surgical site infections (SSIs) are commonly reported postoperative complications after appendectomy. It may lead to recurrent surgery, prolonged hospital stay, and the use of antibiotics. Numerous studies and meta-analyses have described the effect of open versus conventional laparoscopic appendectomy (CLA) that reports faster postoperative recovery and less postoperative pain for CLA. The single-port appendectomy (SPA) has evolved from CLA, with better aesthetics but a greater risk of wound infection. A recent systematic literature review and meta-analysis thus investigated whether reduced port or SPA alters the ratio of SSIs.

It screened Pubmed, Embase, and Cochrane databases for suitable articles. It excluded articles including children below the age of 18, as well as manuscripts that investigated solemnly open appendectomies. 

The study looked for the Incidence of SSI as the primary outcome and duration of operation and length of hospital stay as secondary outcomes.

• It sorted 25 studies through a database search describing 5484 patients.
• It found that 2749 patients received SPA and 2735 received CLA, with no statistical difference in the rate of SSI.
• Twenty-two studies, including 4699 patients, that documented the duration of operation (2223 SPA and 2476 CLA) described a significantly shorter operation time seen in CLA.
• Twenty-three studies (4735 patients: 2235 SPA and 2500 CLA) that documented the length of hospital stay described a shorter hospital stay in the SPA group.
• However, separately performed analyses of randomized controlled trials could not replicate this effect.

Thus, SPA seems to be an equally safe procedure compared to CLA and does not increase the risk of SSI. Only selected patients can benefit from SPA due to its longer operation time and shorter stay.

Köhler F, Reese L, Kastner C, Hendricks A, Müller S, Lock JF, Germer CT, Wiegering A. Surgical Site Infection Following Single-Port Appendectomy: A Systematic Review of the Literature and Meta-Analysis. Front Surg. 2022 Jun 8;9:919744. doi: 10.3389/fsurg.2022.919744. PMID: 35756463; PMCID: PMC9213668.