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



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.


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.


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]).


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.


Laparoscopy Appendectomy Appendicitis Intestinal obstruction 


Conflict of Interest



  1. 1.
    Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology. 2000; 215:337-348.PubMedCrossRefGoogle Scholar
  2. 2.
    Addiss DG, Shaffer N, Fowler BS, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132:910-925.PubMedGoogle Scholar
  3. 3.
    Flum DR, Morris A, Keopsell T, et al. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 2001; 286:1748-1753.PubMedCrossRefGoogle Scholar
  4. 4.
    Semm K. Endoscopic appendectomy. Endoscopy. 1983;15:59-64PubMedCrossRefGoogle Scholar
  5. 5.
    Bennett J, Boddy A, Rhodes M. Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutan Tech. 2007; 17:245-255.PubMedCrossRefGoogle Scholar
  6. 6.
    Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendicectomy: a metaanalysis. J Am Coll Surg. 1998;186:545-553.PubMedCrossRefGoogle Scholar
  7. 7.
    Moberg AC, Montgomery A. Appendicitis: laparoscopic versus conventional operation: a study and review of the literature. Surg Laparosc Endosc. 1997;7:459-463.PubMedCrossRefGoogle Scholar
  8. 8.
    Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst. Rev. 2010;CD001546.Google Scholar
  9. 9.
    Swank HA, Eshius EJ, van Berge Henegouwen MI, et al. Short- and long-term results of open versus laparoscopic appendectomy. World J Surg.2011;35:1221-1226; discussion 1227-1228.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Leung TT, Dixon E, Gill M, et al. Bowel obstruction following appendectomy: what is the true incidence? Ann Surg. 2009;250:51-53.PubMedCrossRefGoogle Scholar
  11. 11.
    Kouhia ST, Heiskanen JT, Huttunen R, et al. Long-term follow-up of a randomized clinical trial of open versus laparoscopic appendicectomy. Br J Surg. 2010;97:1395-1400.PubMedCrossRefGoogle Scholar
  12. 12.
    Angenete E, Jacobsson A, Gellerstedt M, et al. Effect of laparoscopy on the risk of small-bowel obstruction: a population-based register study. Arch Surg. 2012;147:359-365.PubMedCrossRefGoogle Scholar
  13. 13.
    Isaksson K, Montgomery A, Moberg AC, Andersson R, Tingstedt B. Long-term Follow-up for Adhesive Small Bowel Obstruction After Open Versus Laparoscopic Surgery for Suspected Appendicitis. Ann Surg. 2013; 259: 1173-1177CrossRefGoogle Scholar
  14. 14.
    Southgate E, Vousden N, Karthikesalingam A, Markar SR, Black S, Zaida A. Laparoscopic vs. Open appendectomy in older patients. Arch Surg 2012; 147: 557 – 562PubMedCrossRefGoogle Scholar
  15. 15.
    Markar SR, Blackburn S, Cobb R, Karthikesalingam A, Evans J, Kinross J, et al. Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 2012; 16: 1993 – 2004PubMedCrossRefGoogle Scholar
  16. 16.
    Markar SR, Venkat-Raman V, Ho A, Karthikesalingam A, Kinross J, Evans J, et al. Laparoscopic versus open appendicectomy in obese patients. Int J Surg 2011; 9: 451 – 455PubMedCrossRefGoogle Scholar
  17. 17.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986; 7:177 - 187.PubMedCrossRefGoogle Scholar
  18. 18.
    Agresta F, Mazzarolo G, Ciardo LF, Bedin N. The laparoscopic approach in abdominal emergencies: has the attitude changed? A Single-center review of a 15-year experience. Surg Endosc 2008; 22: 1255 – 1262PubMedCrossRefGoogle Scholar
  19. 19.
    Chang HK, Han SJ, Choi SH, Oh JT. Feasibility of a laparoscopic approach for generalize peritonitis from perforated appendicitis in children. Yonsei Med J 2013; 54: 1478 – 1483PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Duron JJ, Hay JM, Msika S, Gaschard D, Domergue J, Gainant A, Fingerhut A. Prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery: a retrospective multicentre study. French Associated for Surgical Research. Arch Surg 2000; 135: 208 – 212Google Scholar
  21. 21.
    Esposito C, Borzi P, Valia JS, Mekki M, Nouri A, Becmeur F, Allal H, Settimi A, Shier F, Sabin MG, Mastroianni L. Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World J Surg 2007; 31: 750 – 755PubMedCrossRefGoogle Scholar
  22. 22.
    Gasior AC, St Peter SD, Knott EM, Hall M, Ostlie DJ, Snyder CL. National trends in approach and outcomes with appendicitis in children. J Pediatr Surg 2012; 47: 2264 – 2267PubMedCrossRefGoogle Scholar
  23. 23.
    Ikeda H, Ishimaru Y, Takayasu H, Okamura K, Kisaki Y, Fujino J. Laparoscopic versus open appendectomy in children with uncomplicated and complicated appendicitis. J Pediatr Surg 2004; 39: 1680 – 1685PubMedCrossRefGoogle Scholar
  24. 24.
    Jen HC, Shew SB. Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis. J Surg Res 2010; 161: 13 – 17PubMedCrossRefGoogle Scholar
  25. 25.
    Kapischke M, Pries A, Caliebe A. Short term and long term results after open vs. laparoscopic appendectomy in childhood and adolescence: a subgroup analysis. BMC Pediatr 2013; 13: 154PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Kapischke M, Friendrich F, Hedderich J, Schulz T, Caliebe A. Laparoscopic versus open appendectomy – quality of life 7 years after surgery. Langenbecks Arch Surg 2011; 396: 69 – 75PubMedCrossRefGoogle Scholar
  27. 27.
    Kaselas C, Molinaro F, Lacreuse I, Becmeur F. Postoperative bowel obstruction after laparoscopic and open appendectomy in children: a 15-year experience. J Pediatr Surg 2009; 44: 1581 – 1585PubMedCrossRefGoogle Scholar
  28. 28.
    Li P, Xu Q, Ji Z, Gao Y, Zhang X, Duan Y, Guo Z, Zheng B, Guo X, Wu X. Comparison of surgical stress between laparoscopic and open appendectomy in children. J Pediatr Surg 2005; 40: 1279 – 1283PubMedCrossRefGoogle Scholar
  29. 29.
    McKinlay R, Neeleman S, Klein R, Stevens K, Greenfield J, Ghory M, Cosentino C. Intraabdominal abscess following open and laparoscopic appendectomy in the pediatric population. Surg Endosc 2003; 17: 730 – 733PubMedCrossRefGoogle Scholar
  30. 30.
    Meguerditchian AN, Prasil P, Cloutier R, Leclerc S, Peloquin J, Roy G. Laparoscopic appendectomy in children: A favourable alternative in simple and complicated appendicitis. J Pediatr Surg 2002; 37: 695 – 698PubMedCrossRefGoogle Scholar
  31. 31.
    Miyano G, Okazaki T, Kato Y, Marusasa T, Takahashi T, Lane GJ, Yamataka A. Open versus laparoscopic treatment for pan-peritonitis secondary to perforated appendicitis in children: a prospective analysis. J Laparoendosc Adv Surg Tech A 2010; 20: 655 – 657PubMedCrossRefGoogle Scholar
  32. 32.
    Nadler EP, Reblock KK, Qureshi FG, Hackam DJ, Gaines BA, Kane TD. Laparoscopic appendectomy in children with perforated appendicitis. J Laparoendosc Adv Surg Tech A. 2006; 16: 159 – 163PubMedCrossRefGoogle Scholar
  33. 33.
    Nataraja RM, Teague WJ, Galea J, Moore L, Haddad MJ, Tsang T, Khurana S, Clarke SA. J Pediatr Surg 2012; 47: 317 – 321PubMedCrossRefGoogle Scholar
  34. 34.
    Nwokoma NJ, Swindells MG, Pahl K, Mathur AB, Minocha A, Kulkami M, Tsang T. Pediatric advanced appendicitis: open versus laparoscopic approach. Surg Laparosc Endosc Percutan Tech 2009; 19: 110 – 113PubMedCrossRefGoogle Scholar
  35. 35.
    Oka T, Kurkchubasche AG, Bussey JG, Wesselhoeft CW Jr, Tracy TF Jr, Luks FI. Open and laparoscopic appendectomy are equally safe and acceptable in children. Surg Endosc 2004; 18: 242 – 245PubMedCrossRefGoogle Scholar
  36. 36.
    Rai R, Chui CH, Sai Prasad TR, Low Y, Yap TL, Jacobsen AS. Perforated appendicitis in children: benefits of early laparoscopic surgery. Ann Acad Med Singapore 2007; 36: 277 – 280PubMedGoogle Scholar
  37. 37.
    Shalak F, Almuhim SI, Ghantous S, Yazbeck S. Laparoscopic appendectomy: burden or benefit? A single-center experience. J Laparoendosc Adv Surg Tech A. 2009; 19: 427 – 429PubMedCrossRefGoogle Scholar
  38. 38.
    Shen Z, Ye Y, Yin M, Wang S. Laparoscopic appendectomy for acute appendicitis versus chronic appendicitis. J Invest Surg 2012; 25: 209 – 213PubMedCrossRefGoogle Scholar
  39. 39.
    Tirabassi MV, Tashjian DB, Moriarty KP, Konefal SH Jr, Courtney RA, Sachs BF. Perforated appendicitis: is laparoscopy safe? JSLS 2004; 8: 147 – 149PubMedCentralPubMedGoogle Scholar
  40. 40.
    Tsao KJ, St Peter SD, Valusek PA, Keckler SJ, Sharp S, Holcomb GW 3rd, Snyder CL, Oslie DJ. Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg 2007; 42: 939 – 942Google Scholar
  41. 41.
    Yagmurlu A, Vernon A, Barnhart DC, Georgeson KE, Harmon CM. Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy. Surg Endosc 2006; 20: 1051 – 1054PubMedCrossRefGoogle Scholar
  42. 42.
    York D, Smith A, von Allmen D, Phillips JD. Laparoscopic appendectomy in children after the learning curve. JSLS 2006; 10: 447 452PubMedCentralPubMedGoogle Scholar
  43. 43.
    Saba AA, Godziachvili V, Mavani AK, et al. Serum levels of interleukin 1 and tumour necrosis factor alpha correlate with peritoneal adhesion grades in humans after major abdominal surgery. Am Surg 1998;64:734-736.PubMedGoogle Scholar
  44. 44.
    Tingstedt B, Isaksson J, Andersson R. Long-term follow up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions. Br J Surg 2007;94:743-748.PubMedCrossRefGoogle Scholar
  45. 45.
    Zbar RI, Crede WB, McKhann CF, et al. The postoperative incidence of small bowel obstruction following standard, open appendicectomy and cholecystectomy: a six year retrospective cohort study at Yale-New Haven Hospital. Conn Med 1993;57:123-127PubMedGoogle Scholar
  46. 46.
    Riber C, Soe K, Jorgensen T, et al. Intestinal obstruction after appendectomy. Scand J Gastroenterol. 1997;32:1125-1128.PubMedCrossRefGoogle Scholar

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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