Laparoscopy or not

Abstract

Both open appendicectomy and laparoscopic appendicectomy have their own advantages and disadvantages. The purpose of our meta-analysis is to compare the surgical effects of laparoscopic versus open appendicectomy. In our study, Medline, Embase, and the Cochrane Library were searched. Only prospective randomized controlled trials that compared the 2 methods of operation were included. Evaluation indexes in our study involved are operating time, complications, hospital stay, time to return to normal activities, time to return to normal diet, and the overall cost. Results showed that operating time of laparoscopic appendicectomy was significantly longer [weighted mean difference (WMD) 7.60; 95% confidence interval (CI) 6.03-9.17 min; P<0.00001]. Time of hospital stay (WMD -0.82; 95% CI: -0.93 to -0.70 d), time to return to normal activities (WMD -6.85; 95% CI: -7.62 to -6.09 d), and diet (WMD -0.61; 95% CI: -0.86 to -0.36 d) were significantly decreased in the laparoscopic appendicectomy group (all P<0.00001). There is no convincing difference in complications (odds ratio 0.99; 95% CI: 0.80-1.22; P=0.92) and death rates (odds ratio 0.97; 95% CI: 0.29-3.25; P=0.96). In conclusion, laparoscopic appendicectomy may have advantages over open appendicectomy in hospital stay and postoperative recovery.

Comparison of clinical outcomes and hospital cost between open appendectomy and laparoscopic appendectomy

“…The operation time of LA group was longer than that of OA group and it was similar with the meta-analysis [13,14]. Because all six surgeons had experience of over 30 cases by laparoscopic procedure each, we believe that the longer operation time of laparoscopic appendectomy was not associated with technical inexperience.…”

“…The reason for lower post-operative ileus occurrence in LA group was thought to be due to laparoscopic procedure reducing interference to the microenvironment and injury to the intestinal serous membrane, then lightened the adherence between the intestines [13]. But, in the literature, there was no statistically significant difference of small bowel obstruction between the two groups [14]. A long observational period is required to assess intestinal obstruction between the two groups.…”

Risk of perforation increases with delay in recognition and surgery for acute appendicitis

“…Lifetime incidence for appendicitis is 8.6% for males and 6.7% for females, with maximal incidence at age 10–14 y in males and 15–19 in females [3]. After a period in which research focused primarily on options for surgical management, including laparoscopy [4] and selective nonoperative management [5], attention has increasingly turned to operative timing during the index admission. The conventional disease model for acute appendicitis was described in the early 20th century [6,7], which proposes a progressive inflammatory process triggered by luminal obstruction of the appendix and culminating in perforation resulting from infection and ischemic necrosis.…”

Acute Appendicitis – Propedeutics and Diagnosis

“…Male and older patients also had an increased risk of intra-abdominal abscess drainage. [7,42,45,48,50] Wound infections are the most common complication, yet they are substantially less common in children than in adults and may not be related to type or timing of antibiotics or to the type of postoperative wound management. [14,42] Mortality from appendectomies has been strongly linked to 2 factors in particular-patient age and diagnosis at time of surgery.…”

“…In contrast, there is a trend towards significance for LA to be associated with lower rates of wound infections and postoperative intestinal obstructions. [7,42,45,48,50] Intra-abdominal or pelvic abscesses may form in the postoperative period after gross contamination of the peritoneal cavity. The patient presents with a swinging pyrexia, and the diagnosis can be confirmed by ultrasonography or computed tomography scanning.…”