Is laparoscopic appendectomy feasible for complicated appendicitis ?A systematic review and meta-analysis

Mei, Yu; Feng, Yufei; Wang, Wei; Fan, Wei; Cheng, Hongyan; Xu, Juan

doi:10.1016/j.ijsu.2017.03.022

Cited by 98 publications

(70 citation statements)

References 45 publications

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“…Regarding cost-effectiveness, intra-abdominal abscess is an especially serious complication and a reported primary drawback of laparoscopic appendectomy. [37] Some authors reported that insu ation and irrigation during laparoscopic appendectomy for complicated appendicitis may increase the incidence of intra-abdominal abscess. [38] [39] This complication leads to a prolonged hospital stay, possible readmission, and the need for subsequent treatment, which increases costs and decreases utility of laparoscopic appendectomy in patients with complicated appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis in Japan

Sugiura

Suzuki²,

Umeyama

et al. 2020

Preprint

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Background: Although evidence regarding the safety and efficacy of nonoperative management is growing, the best treatment strategy for acute complicated appendicitis remains controversial. In this study, we performed a cost-effectiveness analysis of operative management with emergency laparoscopic appendectomy (ELA) alone as the first-line therapy in complicated appendicitis patients in a municipal hospital in Japan.Methods: We constructed a Markov model to compare treatment strategies for complicated appendicitis with emergency laparoscopic appendectomy in otherwise-healthy adults. Health outcomes were measured in quality-adjusted life years (QALYs) gained, and cost-effectiveness was evaluated using an incremental cost effectiveness ratio (ICER). Model variables were abstracted from a literature review, and from data from the hospital records of Tochigi Medical Center. Uncertainty surrounding model parameters was assessed via one-way- and probabilistic-sensitivity analyses. Threshold analysis was performed using the willingness-to-pay threshold set at the World Health Organization's criterion of ¥12 million.Results: Operative management cost ¥677,570 per patient. Nonoperative management without interval laparoscopic appendectomy (ILA) cost ¥109,257 more than operative management and produced only 0.005 more QALYs. Nonoperative management without ILA cost ¥26,049 more than operative management, and also yielded only 0.005 additional QALYs. The ICER for both nonoperative managements were > ¥12 million/QALY in the probabilistic sensitivity analysis.Conclusions : Nonoperative management with ILA and Nonoperative management without ILA were not cost-effective strategies compared with operative management to treat complicated appendicitis. Operative management remains the standard of care, but nonoperative management deserves serious consideration as a treatment option in complicated appendicitis.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis in Japan

Sugiura

Suzuki²,

Umeyama

et al. 2020

Preprint

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“…Yu et al showed laparoscopic appendectomy has more benefit of short length of hospital stays, faster recovery time for oral intake ,and lower rate of surgical site infection than open appendectomy. 3 Wang et al also presented laparoscopic technique is feasible, safe, and efficacious for children with complicated appendicitis. 6 Yeh represented hospital mortality and readmission rates for postoperative complications did not differ between laparoscopic appendectomy and open appendectomy in case of patients with comorbidities, the elderly with complicated appendicitis.…”

Section: Discussionmentioning

confidence: 99%

“…With advances and improvements of laparoscopic instruments and surgeon's technique, CLA has been also applied for treatment of complicated appendicitis such as gangrenous, perforated appendicitis, or periappendiceal abscess. 3 Minimally invasive appendectomy techniques thereafter have been developed, and Single Incision Laparoscopic Appendectomy (SILA) was introduced in 2003. Despite of technical and ergonomic difficulty, SILA has become one of the most popular procedure among the single incision laparoscopic surgery with safety and feasibility in terms of complications, post-operative pain and recovery and better cosmetic results.…”

Section: Introductionmentioning

confidence: 99%

Single Incision Laparoscopic Appendectomy for Management of Complicated Appendicitis: Comparison between Single-Incision and Conventional

Sung

Choi

et al. 2018

J Minim Invasive Surg

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Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). Methods: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. Results: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time (58.97±18.53 (SILA) vs. 57.57±21.48 (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay (2.76±1.41 vs. 3.97±2.97, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). Conclusion: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.

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“…Laparoscopic surgery for uncomplicated appendicitis has been rapidly accepted, as it has several advantages over open surgery . It has also been shown to be feasible and safe for complicated appendicitis, with the advantage of a reduced risk of surgical site infection . Single‐site laparoscopic surgery has developed in recent years due to minimized surgical trauma.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy

Miyo

Urabe

Hyuga

et al. 2019

Annals of Gastroent Surgery

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Aim Single‐site laparoscopic interval appendectomy (SLIA) for severe complicated appendicitis after conservative treatment (CT) to ameliorate inflammation and eradicate the abscess should be safer and less invasive than emergency appendectomy (EA). However, only a few reports have been published regarding SLIA. Methods We retrospectively collected data on 264 consecutive patients admitted to Kinan Hospital for treatment of appendicitis between 2012 and 2018. The safety and feasibility of SLIA and its perioperative outcomes for severe complicated appendicitis were investigated. Results A total of 61 patients were included in this study, 25 of whom underwent CT and 36 EA. Among the 25 patients who underwent CT, 23 (92.0%) succeeded; a total of 16 patients (69.5%) underwent SLIA. Compared to the EA group, the SLIA group had less bleeding (median volume 8.5 vs 50 mL, P = .005) and lower rate of expansion surgery (0% vs 27.8%, P = .022). Although the postoperative hospital stay was shorter in the SLIA group than in the EA group (9 vs 12 days, P = .008), the total hospital stay, including the CT period, was longer in the SLIA group than in the EA group (24 vs 12 days, P < .001). Conclusion SLIA is safe, feasible, and less invasive than EA and may provide the advantages of minimally invasive surgery even if appendicitis is severe. SLIA may be a promising option for complicated appendicitis in select cases despite its disadvantage of prolonging the hospital stay.

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Is laparoscopic appendectomy feasible for complicated appendicitis ?A systematic review and meta-analysis

Abstract: LA was feasible and safe for complicated appendicitis, and it not only could shorten the hospital stays and the time until oral intake, but it could also reduce the risk of surgical site infection.

Cited by 98 publications

References 45 publications

Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis in Japan

Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis in Japan

Single Incision Laparoscopic Appendectomy for Management of Complicated Appendicitis: Comparison between Single-Incision and Conventional

Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy

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