Abstract
Aims
To review and compare the outcomes of laparoscopic (LA) versus open appendicectomy (OA) in complicated appendicitis in adult patients, eight years after the last literature review.
Methods
The PRISMA guidelines were adhered to. Pre-defined inclusion and exclusion criteria were used to search the PubMed, Scopus and Cochrane databases and extract relevant data. Methodological and quality assessment was undertaken with outcome meta-analysis and subgroup analyses of methodological quality, type of study and year of study. Assessment of clinical and statistical heterogeneity and publication bias was conducted.
Results
Three randomised control trials (RCTs) (154LA vs 155OA) and 23 case–control trials were included (2034LA vs 2096OA). Methodological quality was low to average but with low statistical heterogeneity. Risk of publication bias was low, and meta-regression indicated shorter length of hospital stay (LOS) in more recent studies, Q = 7.1, P = 0.007. In the combined analysis LA had significantly less surgical site infections [OR = 0.30 (0.22,0.40); p < 0.00001] with reduced time to oral intake [WMD = -0.98 (-1.09,-0.86); P < 0.00001] and LOS [WMD = -3.49(-3.70,-3.29); p < 0.00001]. There was no significant difference in intra-abdominal abscess rates [OR = 1.11(0.85,1.45); p = 0.43]. Operative time was longer during LA [WMD = 10.51 (5.14,15.87); p = 0.0001] but did not reach statistical significance (p = 0.13) in the RCT subgroup analysis.
Conclusions
LA appears to have significant benefits with improved morbidity compared to OA in complicated appendicitis (level of evidence II).
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References
Anderson JE, Bickler SW, Chang DC et al (2012) Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995–2009. World J Surg 36:2787–2794
Buckius MT, McGrath B, Monk J et al (2012) Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. J Surg Res 175:185–190
Masoomi H, Nguyen NT, Dolich MO et al (2014) Laparoscopic Appendectomy Trends and Outcomes in the United States: data from the Nationwide Inpatient Sample (NIS), 2004‐2011. Am Surg 80:1074–1077
Markides G, Subar D, Riyad K (2010) Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 34:2026–2040
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269
Quezada F, Quezada N, Mejia R et al (2015) Laparoscopic versus open approach in the management of appendicitis complicated exclusively with peritonitis: a single center experience. Int J Surg 13:80–83
Taguchi Y, Komatsu S, Sakamoto E et al (2016) Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surg Endosc 30:1705–1712
Thomson J-E, Kruger D, Jann-Kruger C et al (2015) Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety. Surg Endosc 29:2027–2032
Yeom S, Kim MS, Park S et al (2014) Comparison of the outcomes of laparoscopic and open approaches in the treatment of periappendiceal abscess diagnosed by radiologic investigation. J Laparoendosc Adv Surg Tech 24:762–769
Dimitriou I, Reckmann B, Nephuth O et al (2013) Single institution’s experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis. Langen Arch Surg 398:147–152
Galli R, Banz V, Fenner H et al (2013) Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection? Surg Endosc 27:2928–2933
Mohamed AA, Mahran KM (2013) Laparoscopic appendectomy in complicated appendicitis: is it safe? J Minim Access Surg 9:55
Wilson DG, Bond AK, Ladwa N et al (2013) Intra-abdominal collections following laparoscopic versus open appendicectomy: an experience of 516 consecutive cases at a district general hospital. Surg Endosc 27:2351–2356
Ferranti F, Corona F, Siani L et al (2012) Laparoscopic versus open appendectomy for the treatment of complicated appendicitis. G Chir 33:263–267
Schietroma M, Piccione F, Carlei F et al (2012) Peritonitis from perforated appendicitis: stress response after laparoscopic or open treatment. Am Surg 78:582–590
Lim SG, Ahn EJ, Kim SY et al (2011) A clinical comparison of laparoscopic versus open appendectomy for complicated appendicitis. J Korean Soc Coloproctol 27:293–297
Garg CP, Vaidya BB, Chengalath MM (2009) Efficacy of laparoscopy in complicated appendicitis. Int J Surg 7:250–252
Kehagias I, Karamanakos SN, Panagiotopoulos S et al (2008) Laparoscopic versus open appendectomy: which way to go. World J Gastroenterol 14:4909–4914
Park H-C, Yang D-H, Lee B-H (2009) The laparoscopic approach for perforated appendicitis, including cases complicated by abscess formation. J Laparoendosc Adv Surg Tech 19:727–730
Sleem R, Fisher S, Gestring M et al (2009) Perforated appendicitis: is early laparoscopic appendectomy appropriate? Surgery 146:731–738
Guller U, Hervey S, Purves H et al (2004) Laparoscopic versus open appendectomy. Ann Surg 239:43–52
So JB, Chiong E-C, Chiong E et al (2002) Laparoscopic appendectomy for perforated appendicitis. World J Surg 26:1485–1488
Kirshtein B, Bayme M, Domchik S et al (2007) Complicated appendicitis: laparoscopic or conventional surgery? World J Surg 31:744–749
Stöltzing H, Thon K (2001) Perforated appendicitis: is laparoscopic operation advisable? Dig Surg 17:610–616
Piksun G, Kozic D, Rajpal S et al (2001) Comparison of laparoscopic, open and converted appendectomy for perforated appendicitis. Surg Endosc 15:660–662
Fukami Y, Hasegawa H, Sakamoto E et al (2007) Value of laparoscopic appendectomy in perforated appendicitis. World J Surg 31:93–97
Yau KK, Siu WT, Tang CN et al (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205:60–65
Pokala N, Sadhasivam S, Kiran RP et al (2007) Complicated appendicitis—is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. Am Surg 73:737–742
Kim H, Lee I, Lee Y et al (2009) A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer. Surg Endosc 23:1812–1817
Khalili TM, Hiatt JR, Savar A et al (1999) Perforated appendicitis is not a contraindication to laparoscopy. Am Surg 65:965–967
Wullstein C, Barkhausen S, Gross E (2001) Results of laparoscopic vs. conventional appendectomy in complicated appendicitis. Dis Colon Rectum 44:1700–1705
Lin H-F, Wu J-M, Tseng L-M et al (2006) Laparoscopic versus open appendectomy for perforated appendicitis. J Gastrointest Surg 10:906–910
Katsuno G, Nagakari K, Yoshikawa S et al (2009) Laparoscopic appendicectomy for complicated appendicitis: a comparison with open appendicectomy. World J Surg 33:208–214
Masoomi H, Nguyen NT, Dolich MO et al (2011) Comparison of laparoscopic versus open appendectomy for acute nonperforated and perforated appendicitis in the obese population. Am J Surg 202:733–739
Ukai T, Shikata S, Takeda H et al (2016) Evidence of surgical outcomes fluctuates over time: results from a cumulative meta-analysis of laparoscopic versus open appendectomy for acute appendicitis. BMC Gastroenterol 16:1–12
Masoomi H, Mills S, Dolich M et al (2012) Comparison of outcomes of laparoscopic versus open appendectomy in children: data from the Nationwide Inpatient Sample (NIS), 2006–2008. World J Surg 36:573–578
Tiwari MM, Reynoso JF, Tsang AW et al (2011) Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 254:927–932
Tuggle KR-M, Ortega G, Bolorunduro OB et al (2010) Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database. J Surg Res 163:225–228
Yeh C, Wu S, Liao C et al (2011) Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study. Surg Endosc 25:2932–2942
Markar SR, Penna M AH (2014) Laparoscopic approach to appendectomy reduces the incidence of short- and long-term post-operative bowel obstruction: systematic review and pooled analysis. J Gastrointest Surg 18:1683–1692
Werkgartner G, Cerwenka H, El Shabrawi A et al (2015) Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients. Int J Colorectal Dis 30:397–401
Bulian DR (2015) Invited commentary on” Werkgartner G. et al.: laparoscopic versus open appendectomy for complicated appendicitis in high risk patients”. Int J Colorectal Dis 30:567
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Athanasiou, C., Lockwood, S. & Markides, G.A. Systematic Review and Meta-Analysis of Laparoscopic Versus Open Appendicectomy in Adults with Complicated Appendicitis: an Update of the Literature. World J Surg 41, 3083–3099 (2017). https://doi.org/10.1007/s00268-017-4123-3
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DOI: https://doi.org/10.1007/s00268-017-4123-3