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Journal of Gastrointestinal Surgery

, Volume 18, Issue 9, pp 1683–1692 | Cite as

Laparoscopic Approach to Appendectomy Reduces the Incidence of Short- and Long-Term Post-operative Bowel Obstruction: Systematic Review and Pooled Analysis

  • Sheraz R. MarkarEmail author
  • Marta Penna
  • Adrian Harris
Review Article

Abstract

Background

The aim of this meta-analysis was to determine the effect of laparoscopic appendectomy (LA) compared to open appendectomy (OA) on short-term and long-term post-operative bowel obstruction.

Methods

Medline, Embase, trial registries, conference proceedings and reference lists were searched. Subset analysis was performed for paediatric patients, patients who presented with perforated appendicitis and studies with long-term follow-up and surveillance for bowel obstruction and with surgery for bowel obstruction.

Results

Overall, 29 studies comprising 159,729 patients (60,875 LA versus 98,854 OA) were included. LA was associated with a significant reduction in the incidence of post-operative bowel obstruction in the general population (pooled odds ratio (POR) = 0.43 [95 %C.I. 0.3–0.63]). Subset analysis demonstrated that LA significantly reduced the incidence of post-operative bowel obstruction in paediatric patients (POR = 0.48 [95 %C.I. 0.3–0.78]) and patients with perforated appendicitis (POR = 0.44 [95 %C.I. 0.26–0.74]). Furthermore, LA was associated with a significantly reduced incidence of long-term bowel obstruction (POR = 0.33 [95 %C.I. 0.19–0.56]) and bowel obstruction requiring surgery (POR = 0.31 [95 %C.I. 0.2–0.48]).

Discussions

This present meta-analysis provides evidence to clearly demonstrate the benefits of a laparoscopic approach to appendectomy as reflected by a reduction in short- and long-term adhesive bowel obstruction. Important future areas for assessment include the influence of surgical approach on long-term quality of life following appendectomy.

Keywords

Laparoscopy Appendectomy Appendicitis Intestinal obstruction 

Notes

Conflict of Interest

None

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Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Sheraz R. Markar
    • 1
    • 3
    Email author
  • Marta Penna
    • 2
  • Adrian Harris
    • 1
  1. 1.Department of Laparoscopic SurgeryHinchingbrooke Healthcare TrustHuntingdonUK
  2. 2.Department of General SurgeryWhittington HospitalLondonUK
  3. 3.Department of Laparoscopic and Upper Gastro-Intestinal SurgeryHinchingbrooke Healthcare NHS TrustHuntingdonUK

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