Systematic review and meta-analysis comparing outcomes of multi-port versus single-incision laparoscopic surgery (SILS) in Hartmann’s reversal

Background Colostomy formation as part of the Hartmann’s procedure is often performed during emergency surgery as a damage limitation measure where attempts at bowel anastomosis and continuity are contraindicated. Hartmann’s reversal (HR) remains challenging and can be attempted through open surgery and various minimally invasive techniques (laparoscopic and robotic platforms). We aimed to analyse outcomes of conventional multi-port laparoscopy (CL) versus single-incision approach (SILS) in patients undergoing HR. Methods A comprehensive online search of various databases was conducted in accordance with PRISMA guidelines including Medline, PubMed, Embase, and Cochrane. Comparative studies of patients undergoing CL and SILS for HR were included. Analysed primary outcomes were total operative time and mortality rate. Secondary outcomes included post-operative complications, length of hospital stay, risk of visceral injury intra-operatively, and re-operation rate. Combined overall effect sizes were calculated using the random-effects model, and the Newcastle–Ottawa Scale (NOS) was used to assess bias. Results Two observational studies matching our inclusion criteria with a total of 160 patients (SILS 100 vs. CL 60) were included. Statistical difference was observed for one outcome measure: operative duration (MD − 44.79 CI − 65.54– − 24.04, P