Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials

Abstract

BackgroundSeveral systematic reviews (SRs) of randomised controlled trials (RCTs) comparing laparoscopic versus open appendectomy have been published, but there has been no overview of SRs of these two interventions. This overview (review of review) aims to summarise the results of such SRs in order to provide the most up to date evidence, and to highlight discordant results.MethodsMedline, Embase, Cinahl, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects were searched for SRs published up to August 2014. Study selection and quality assessment using the AMSTAR tool were carried out independently by two reviewers. We used standardised forms to extract data that were analysed descriptively.ResultsNine SRs met the inclusion criteria. All were of moderate to high quality. The number of randomized controlled trials (RCTs) they included ranged from eight to 67. The duration of surgery pooled by eight reviews was 7.6 to 18.3 minutes shorter using the open approach. Pain scores on the first postoperative day were lower after laparoscopic appendectomy in two out of three reviews. The risk of abdominal abscesses was higher for laparoscopic surgery in half of six meta-analyses. The occurrence of wound infections pooled by all reviews was lower after laparoscopic appendectomy. One review showed no difference in mortality. The laparoscopic approach shortened hospital stay from 0.16 to 1.13 days in seven out of eight meta-analyses, though the strength of the evidence was affected by strong heterogeneity.ConclusionLaparoscopic and open appendectomy are both safe and effective procedures for the treatment of acute appendicitis. This overview shows discordant results with respect to the magnitude of the effect but not to the direction of the effect. The evidence from this overview may prove useful for the development of clinical guidelines and protocols.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-015-0277-3) contains supplementary material, which is available to authorized users.

Laparoscopic Abdominal Surgery Under Regional Anesthesia: A Retrospective Evaluation

“…Minimal invaziv bir girişim olmasına bağlı olarak daha kısa hastanede yatış süresi, gündelik aktiviteye hızlı dönüş, daha iyi kozmetik sonuçlar, postoperatif ağrı ve analjezik ihtiyacının daha az olması, daha düşük yara yeri enfeksiyonu insidansı, perioperatif ve postoperatif mortalite ve morbiditede iyileşme laparoskopik cerrahinin açık cerrahiye olan üstünlükleridir (2,3).…”

Comparison of Short-Term Outcome between Laparoscopic and Open Appendectomy in Adults: A Meta-Analysis of Randomized Controlled Trials

“…Appendicitis is the most common cause for acute abdominal pain with a life-time incidence between 6.7% and 8.6% [1,2]. It is also the most common emergency in abdominal surgery [3].…”

Abordaje laparoscópico frente a enfoque clásico en el tratamiento de la apendicitis aguda

“…En otro metaanálisis publicado en 2010, Li, et al 8 , analizaron 5.292 pacientes y obtuvieron resultados similares a los de Sauerland, menor tasa de infección del sitio operatorio y mayor tasa de abscesos intraabdominales, en la cohorte de apendicectomía laparoscópica. También, Jaschinski, et al 9 , en una revisión sistemática de metaanálisis publicada en 2015, encontraron que la apendicectomía laparoscópica tenía menos problemas de infección del sitio operatorio, aunque mayores tasas de abscesos intraabdominales. Minutolo, et al 10 , en 2014, analizaron 230 pacientes intervenidos por apendicitis aguda, comparando la técnica laparoscó-pica con la abierta; encontraron un mayor número, estadísticamente significativo, de infecciones del sitio operatorio en el grupo de apendicectomía laparoscópica, sin significación estadística en el número de abscesos abdominales.…”