Laparoscopic Versus Open Appendectomy in Adults with Complicated Appendicitis: Systematic Review and Meta‐analysis

Markides, G.; Subar, Daren; Riyad, Kallingal

doi:10.1007/s00268-010-0669-z

Cited by 152 publications

(124 citation statements)

References 56 publications

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“…8 In patients with complicated appendicitis, it has been shown to reduce the rate of surgical site infection without a difference in post-operative intra-abdominal abscess formation. 12 The advantages of LA in male patients are less clear with a randomised trial from 2010 demonstrating no advantages and even an increased operative time compared to OA.…”

mentioning

confidence: 99%

Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

Markar

Karthikesalingam

Cunningham

et al. 2011

annals

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Acute appendicitis is the most common abdominal emergency and accounts for roughly 40,000 hospital admissions in England per year. 1 In the past, acute appendicitis was solely a 'bedside diagnosis' based on the patient's medical history and physical examination, with laboratory investigations only helping with the interpretation of clinical findings. 2 The main attraction of ultrasonography (US) is that it is a safe, inexpensive and readily available imaging modality. It is particularly useful for visualising pelvic anatomy and ruling out gynaecological causes of lower abdominal pain in female patients. The disadvantages of US include its inability to provide adequate information in obese patients and the operator dependent nature of its results.3 This is reflected in the significant heterogeneity in reported rates of sensitivity and specificity of US in diagnosing acute appendicitis. 3-5Computed tomography (CT) has been shown to have both a high sensitivity and specificity in diagnosing acute appendicitis, leading to a further reduction in the negative appendicectomy rate. 4,6,7 Laparoscopy provides a method to accurately visualise the appendix and other abdominal contents that may be the cause of acute lower abdominal pain. Laparoscopic appendicectomy (LA) has been shown to reduce wound morbidity (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.35-0.58), post-operative pain (reduced by 9mm on a 100mm visual analogue pain scale) and length of hospital stay (shortened by 1.1 days, 95% CI: 0.6-1.5) compared to traditional open appendicectomy (OA). 8 The aim of this study was to document changes in the diagnostic and therapeutic processes of patients who underwent surgery for suspected acute appendicitis and evaluate the impact of these processes on clinical outcomes during two twelve-month periods separated by ten years. 620Ann CONCLUSIONS This study shows that significant increase in the use of pre-operative imaging and laparoscopy in the management of patients with acute appendicitis failed to reduce negative appendicectomy, perforation and complications rates. The patient's age was the only predictor of negative appendicectomy and perforation.

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mentioning

confidence: 99%

Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

Markar

Karthikesalingam

Cunningham

et al. 2011

annals

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“…There was reported increase in incidence of intraabdominal abscess after LA [Peto odds ratio 1.87 (95 % confidence interval (CI) 1.19-2.93)] in 2010 Cochrane review [9], but in a systematic review, Markides et al reported this increase to be of no statistical significance [odds ratio (OR) 1.24 (95 % CI 0.84-1.84)] [10]. Intra-operative irrigation and suction continues to be a matter of debate.…”

Section: Appendicitismentioning

confidence: 99%

Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status

et al. 2014

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Laparoscopy has already established itself as the preferred surgical approach in a variety of elective surgical conditions. Along with its usual advantages of less tissue trauma and faster recovery, its diagnostic as well as therapeutic role is making it an attractive option in emergency surgery. In this paper, we have reviewed the current status of laparoscopic surgery in luminal gastrointestinal emergencies. Relevant papers were selected using Medline database from 2007 to the present. These were reviewed, and outcomes were stated under the headings of appendicitis, perforated peptic ulcer, colorectal emergencies and small bowel obstruction. The laparoscopic intervention was found to be of clear benefit in most of the patients with appendicitis. Its role, however, is not absolutely clear in managing perforated peptic ulcers. Laparoscopic lavage and drainage have been recommended in diverticular perforation with limited contamination. Small case series and studies have shown benefits of laparoscopic surgery in iatrogenic colonic perforations, colonic obstruction, emergency colectomy and small bowel obstruction. Laparoscopic surgery can be recommended in appendicitis and lowrisk cases of perforated peptic ulcers. Its definitive role in other conditions needs more evidence. The surgeon's experience and careful patient selection are very important to improve the outcome.

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“…LA can be considered the gold standard in premenopausal women (LE 1a) [98], and it is feasible in the elderly (LE 3) [99] and the obese (LE 3) [100], but in men LA has no advantages compared with open appendectomy (OA) (LE 1b) [101]. Complicated appendicitis can be approached laparoscopically, with significant improvement of the surgical site (SS) infection rate (a minor advantage according to Clavien's criteria) (LE 3a) [102,103]. Thorough peritoneal lavage ( [6-8 L) and aspiration are recommended in complicated appendicitis (LE 5) in order to minimize the abscess formation rate [104].…”

Section: Acute Appendicitismentioning

confidence: 99%

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

et al. 2012

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Background In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. Methods Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association.

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Laparoscopic Versus Open Appendectomy in Adults with Complicated Appendicitis: Systematic Review and Meta‐analysis

Abstract: When compared to OA, laparoscopic appendectomy is advantageous in CA with regard to SSIs, with no significant additional risk of IAA (level 3a evidence).

Cited by 152 publications

References 56 publications

Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status

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