Meta-analysis of the clinical efficacy of laparoscopic appendectomy in the treatment of acute appendicitis

Abstract

Background This paper compares the postoperative recovery of patients with acute appendicitis (AA) after laparoscopic appendectomy (LA) and open appendectomy (OA), aiming to determine the optimal diagnosis and treatment plan for appendectomy. Methods Related literature was retrieved from PubMed, Web of Science, Embase, CNKI and Wanfang databases. Articles on LA and OA for AA published between 2010 and 2021 were selected to extract data. Besides, Stata16.0 was used for meta-analysis. Results A total of 777 articles were retrieved, and 16 of them were finally selected. Totally, 1251 patients underwent LA, while 898 patients received OA. According to the results of meta-analysis, LA was associated with lower incidence of adverse reactions [OR = 0.257, 95% CI (0.162, 0.408), P < 0.001], shorter operation time (SMD = − 1.802, 95% CI − 2.435, − 1.169; P < 0.001) and hospitalization (SMD = − 1.184, 95% CI − 1.512, − 0.856; P < 0.001). In addition, compared with the OA group, LA was found with less intraoperative blood loss (SMD = − 3.650, 95% CI − 5.088, − 2.212; P < 0.001) and shorter recovery time of gastrointestinal function (SMD = − 3.010, 95% CI − 3.816, − 2.203; P < 0.001). Aside from all these, the counts of leukocyte (SMD = − 0.432, 95% CI: − 0.775, − 0.089; P = 0.013), neutrophil (SMD = − 1.346, 95% CI − 2.560, − 0.133; P = 0.030), and C-reactive protein (SMD = − 2.391, 95% CI − 3.901, − 0.882; P = 0.002) all decreased in a significant manner after LA. Conclusion Compared with OA, LA boasts the advantages of less adverse reactions, shorter operation time and hospitalization, fewer complications, and lower inflammatory response, evidencing its safety and feasibility of applying in the treatment of AA.

Nuevo sistema de calificación diagnóstica para apendicitis pediátrica basado en parámetros hematológicos ajustados por edad y sexo

“…Aunque la apendicitis aguda es una de las emergencias quirúrgicas más comunes en la infancia, el diagnóstico sigue siendo un desafío debido a su posible presentación clínica atípica. 7 De tal forma, para superar las dificultades en el diagnóstico de apendicitis aguda y definir una herramienta estandarizada para tal fin, se han propuesto docenas de diferentes parámetros y puntuaciones clínicas, de laboratorio y radiológicos. 7,8 Desafortunadamente, ninguno ha sido lo suficientemente útil para el diagnóstico diferencial entre patologías abdominales agudas quirúrgicas y patologías no quirúrgicas.…”

“…7 De tal forma, para superar las dificultades en el diagnóstico de apendicitis aguda y definir una herramienta estandarizada para tal fin, se han propuesto docenas de diferentes parámetros y puntuaciones clínicas, de laboratorio y radiológicos. 7,8 Desafortunadamente, ninguno ha sido lo suficientemente útil para el diagnóstico diferencial entre patologías abdominales agudas quirúrgicas y patologías no quirúrgicas. A pesar de todos los esfuerzos, el número de exploraciones negativas aún no ha disminuido como se deseaba.…”

A Novel Diagnostic Scoring System for Pediatric Appendicitis Based on Age and Sex-Adjusted Hematological Parameters

“…Although acute appendicitis (AA) is one of the most common surgical emergency in childhood, diagnosis still remains challenging due to its potential atypical clinical presentation [7]. In this way, to accomplish the di culties in diagnosis of AA and to de ne a standardized diagnostic tool for the diagnosis of acute appendicitis; dozens of different clinical, laboratory and radiological parameters and scores have been declared [7,8]. But unfortunately, none of them could be helpful enough to distinguish the differential diagnosis of surgical acute abdominal pathologies from non-surgical pathologies.…”

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

“…Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely accepted and adopted in elective digestive surgery [ 1 – 5 ]. On the contrary, its application in emergency settings is reserved for a number of selected interventions, mainly approached by laparoscopy [ 6 , 7 ]. Based on a recent WSES survey conducted amongst 415 surgeons from 67 different countries, laparoscopy was employed for primary emergencies in more than 50% of patients by only 28.7% of participants [ 8 ].…”