Skip to main content
Log in

Laparoscopic Versus Open Appendectomy in Adults with Complicated Appendicitis: Systematic Review and Meta-analysis

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The goal of the present study was to critically review and identify the strength of available evidence in the literature on the use of laparoscopic appendectomy (LA) in complicated appendicitis (CA).

Methods

The Cochrane Library and Controlled Trials Registry, MEDLINE (Ovid), PubMed, Web of knowledge, and SCOPUS databases were electronically searched, using the keywords “appendectomy,” “laparoscopy,” “appendicitis.” “complicated appendicitis.” “gangrenous appendicitis,” “perforated appendicitis,” with English language as a limit. Backward chaining was also employed. The NHS Public Health Resource Unit Critical Appraisal Skills Programme Tools were used for critical appraisal.

Results

Twelve retrospective case-control studies were included in the review. Overall methodological quality was moderate to poor, with heterogeneity, absence of randomization and blinding, and presence of important methodological flaws. Meta-analysis showed that LA in CA has reduced surgical site infection (SSI) rates compared to open appendectomy (OA), odds ratio (OR) 0.23, 95% confidence intervals (CI): 0.14–0.37 (level 3a evidence), and no difference with regard to intra-abdominal abscess (IAA) complication rates OR: 1.02, 95% CI 0.56–1.86 (level 3a evidence).

Conclusions

When compared to OA, laparoscopic appendectomy is advantageous in CA with regard to SSIs, with no significant additional risk of IAA (level 3a evidence).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Rosenberg W, Donald A (1995) Evidence based medicine: an approach to problem solving. BMJ 310:1122–1126

    CAS  PubMed  Google Scholar 

  2. Williams NMA, Everson NW, Jackson D, Johnstone JM (1998) Is the incidence of acute appendicitis really falling? Ann R Coll Surg Engl 80:122–124

    CAS  PubMed  Google Scholar 

  3. Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925

    CAS  PubMed  Google Scholar 

  4. Livingston E, Woodward W, Sarosi GA, Haley RW (2007) Disconnect between incidence of nonperforated and perforated appendicitis. Implications for pathophysiology and management. Ann Surg 245:886–892

    Article  PubMed  Google Scholar 

  5. Oliak D, Yamini D, Udani V, Lewis RJ, Vargas H, Arnell T, Stamos M (2007) Can perforated appendicitis be diagnosed pre-operatively based on admission factors? J Gastrointest Surg 4:470–474

    Article  Google Scholar 

  6. Humes DJ, Simpson J (2006) Acute appendicitis. BMJ 333:530–534

    Article  CAS  PubMed  Google Scholar 

  7. Blomqvist PG, Anderson RE, Granath F, Lambe MP, Ekborn AR (2001) Mortality after appendectomy in Sweden, 1987–1996. Ann Surg 233:455–460

    Article  CAS  PubMed  Google Scholar 

  8. McBurney C (1894) The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 20:38

    Article  CAS  PubMed  Google Scholar 

  9. Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64

    Article  CAS  PubMed  Google Scholar 

  10. Sauerland S, Lefering R, Neugebauer EAM (2004) Laparoscopic versus open appendicectomy for suspected appendicitis (review). Cochrane Database of Systematic Reviews Issue 3. Art. No CD001546. doi:10.1002/14651858.CD001546.pub2

  11. Pedersen AG, Petersen OB, Wara P, Renning H, Qvist N, Laurberg S (2001) Randomised control trial of laparoscopic versus open appendectomy. Br J Surg 88:200–205

    Article  CAS  PubMed  Google Scholar 

  12. Fukami Y, Hasegawa H, Sakamoto E, Komatsu S, Hiromatsu T (2007) Value of laparoscopic appendectomy in perforated appendicitis. World J Surg 31:93–97

    Article  PubMed  Google Scholar 

  13. Kirshtein B, Bayme M, Domchik S, Mizrahi S, Lantsberg L (2007) Complicated appendicitis: laparoscopic or conventional surgery? World J Surg 31:744–749

    Article  PubMed  Google Scholar 

  14. NHS P H R U (2008) Critical Appraisal Skills Programme—10 questions to help you make sense of randomised control trials. Accessed 17 January 2009

  15. NHS P H R U (2008) Critical Appraisal Skills Programme—10 questions to help you make sense of a case control study. Accessed 17 January 2009

  16. Higgins JPT, Green S (eds) (2008) Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008] The Cochrane Collaboration. www.cochrane-handbook.org

  17. Centre TNC, Review Manager (RevMan). 2008 The Cochrane Collaboration: Copenhagen

  18. Oxford Centre of Evidence Based Medcine (2009) Levels of evidence. Accessed April 2009

  19. Sileri P, Gentileschi P, Sica GS, Rossi P, Franceschilli L, Perrone F, Gaspari AL (2008) Abstract: laparoscopic appendectomy for complicated appendicitis. Society for Surgery of the Alimentary Tract 2008 Abstracts T1715:A–883

  20. Cueto J, D’Allemagne B, Vazquez-Frias JA, Gomez S, Delgado F, Trullenque L, Fajardo R, Valencia S, Poggi L, Balli J, Diaz J, Gonzalez R, Mansur JH, Franklin ME (2006) Morbidity of laparoscopic surgery for complicated appendicitis: an international study. Surg Endosc 20:717–720

    Article  CAS  PubMed  Google Scholar 

  21. Kiriakopoulos A, Tsakayiannis D, Linos D (2006) Laparoscopic management of complicated appendicitis. J Soc Lap Surg 10:453–456

    Google Scholar 

  22. Towfigh S, Chen F, Mason R, Katkhouda N, Chan L, Berne T (2006) Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis. Surg Endosc 20:495–499

    Article  CAS  PubMed  Google Scholar 

  23. Mancini GJ, Mancini ML, Nelson HS (2005) Efficacy of laparoscopic appendectomy in appendicitis with peritonitis. Am Surg 71:1–4

    PubMed  Google Scholar 

  24. Ball CG, Kortbeek JB, Kirkpatrick AW, Mitchell P (2004) Laparoscopic appendectomy for complicated appendicitis: an evaluation of post-operative factors. Surg Endosc 18:969–973

    Article  CAS  PubMed  Google Scholar 

  25. Johnston AB, Peetz ME (1998) Laparoscopic appendectomy is an acceptable alternative for the treatment of perforated appendicitis. Surg Endosc 12:940–943

    Article  Google Scholar 

  26. Lachin JM, Matts JP, Wei LJ (1988) Randomisation in clinical trials: conclusions and recommendations. Control Clin Trial 9:365–374

    Article  CAS  Google Scholar 

  27. Schulz KF, Grimes DA (2002) Blinding in randomised trials: hiding who got what. Lancet 359:696–700

    Article  PubMed  Google Scholar 

  28. Schulz KF, Grimes DA (2002) Allocation concealment in randomised trials: defending against deciphering. Lancet 359:614–618

    Article  PubMed  Google Scholar 

  29. Pokala N, Sadhasivam S, Kiran RP, Parithivel V (2007) Complicated appendicitis—is the laparoscopic approach appropriate? A comparative study with the open approach: Outcome in a community hospital setting. Am Surg 73:737–741

    PubMed  Google Scholar 

  30. Yau KK, Siu WT, Tang CN, Yang GPC, Li MKW (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205:60–65

    Article  PubMed  Google Scholar 

  31. Katsuno G, Nagakari K, Yoshikawa S, Sugiyama K, Fukunaga M (2009) Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy. World J Surg 33:208–214

    Article  PubMed  Google Scholar 

  32. Piksun G, Kozic D, Rajpal S, Shaftan G, Fogler R (2001) Comparison of laparoscopic, open and converted appendectomy for perforated appendicitis. Surg Endosc 15:660–662

    Article  Google Scholar 

  33. Stoltzing H, Thon K (2000) Perforated appendicitis: is laparoscopic operation adviseable? Digest Surg 17:610–616

    Article  CAS  Google Scholar 

  34. Wullstein C, Barkhausen S, Gross E (2001) Results of laparoscopic vs conventional appendectomy in complicated appendicitis. Dis Colon Rectum 44:1700–1705

    Article  CAS  PubMed  Google Scholar 

  35. Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks E, Pietrobon P (2004) Laparoscopic versus open appendectomy. Outcomes comparison based on a large administrative database. Ann Surg 239:43–52

    Article  PubMed  Google Scholar 

  36. So JBY, Chiong E-C, Chiong E, Cheah W-K, Lomanto D, Goh P, Kum C-K (2002) Laparoscopic appendectomy for perforated appendicitis. World J Surg 26:1485–1488

    Article  PubMed  Google Scholar 

  37. Lin H-F, Wu J-M, Tseng L-M, Chen K-H, Huang S-H, Lai I-R (2006) Laparoscopic versus open appendectomy for perforated appendicitis. J Gastrointest Surg 10:906–910

    Article  PubMed  Google Scholar 

  38. Brewer M (2000) Research design and issues of validity. Cambridge University Press, Cambridge

    Google Scholar 

  39. Henry MC, Moss RL (2005) Primary versus delayed wound closure in complicated appendicitis: an international systematic review and meta-analysis. Ped Surg Intern 21:625–630

    Article  Google Scholar 

  40. Greenwood PE, Nikulin MS (1996) A Guide to Chi-Squared Testing. Wiley, New York

    Google Scholar 

  41. Fisher RA (1922) On the interpretation of χ2 from contingency tables, and the calculation of P. J R Stat Soc 85:87–94

    Article  Google Scholar 

  42. Lachin JM (2000) Statistical considerations in the intent-to-treat principle. Control Clin Trial 21:167–189

    Article  CAS  Google Scholar 

  43. Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Erlbaum Associates, Mahwah

    Google Scholar 

  44. Khalili TM, Hiatt JR, Savar A, Lau C, Margulies DR (1999) Perforated appendicitis is not a contraindication to laparoscopy. Am Surg 65:965–967

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Georgios Markides.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Markides, G., Subar, D. & Riyad, K. Laparoscopic Versus Open Appendectomy in Adults with Complicated Appendicitis: Systematic Review and Meta-analysis. World J Surg 34, 2026–2040 (2010). https://doi.org/10.1007/s00268-010-0669-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-010-0669-z

Keywords

Navigation