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Evidence to support the use of laparoscopic over open appendicectomy for obese individuals: a meta-analysis

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Abstract

Background

Laparoscopic appendicectomy (LA) in the obese population has been controversial. A recent SAGES guideline and a Cochrane Review have suggested a benefit for LA over the open approach but did not provide supporting data. This study is the first systematic review and meta-analysis to compare the LA with open surgery in the obese population to provide a quantitative estimate of the relative benefits.

Methods

A comprehensive search of the online databases identified seven retrospective and prospective randomized studies that contained sufficient data on obese patients. Analysis was based on intention-to-treat. We calculated pooled odds ratios (ORs) and 95 % confidence intervals using a random-effects model.

Results

The LA group contained more females (43 vs. 32 %, p < 0.001), had fewer perforations (18 vs. 23 %; p < 0.001), and fewer overall complications (OR: 0.49; 95 % CI: 0.37–0.63), including fewer wound infections (OR: 0.34; 95 % CI: 0.18-0.66). There was no difference in the intra-abdominal abscess rate between the groups (OR: 0.99; 95 % CI: 0.29-3.37). The LA group had a shorter length of stay (2.46 vs. 3.63 days; p < 0.001) but a longer operation time (96 vs. 78 min, p < 0.001). There was no heterogeneity between the studies.

Conclusions

This meta-analysis of the current published data establishes the laparoscopic approach to appendicectomy as the preferred technique for the obese population, delivering a 50 % reduction in morbidity, with a 66 % reduction in wound infections and a significantly shorter inpatient hospital stay without increasing the intra-abdominal abscess rate.

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Disclosures

B. L. Woodham, M. R. Cox, and G. D. Eslick have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Nepean Hospital, Penrith, NSW, Australia

    Benjamin L. Woodham, Michael R. Cox & Guy D. Eslick

  2. The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Sydney Medical School, Nepean Hospital, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia

    Michael R. Cox & Guy D. Eslick

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  1. Benjamin L. Woodham
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  2. Michael R. Cox
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Correspondence to Guy D. Eslick.

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Woodham, B.L., Cox, M.R. & Eslick, G.D. Evidence to support the use of laparoscopic over open appendicectomy for obese individuals: a meta-analysis. Surg Endosc 26, 2566–2570 (2012). https://doi.org/10.1007/s00464-012-2233-4

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