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Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety

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Abstract

Background

To date, no randomized control trial has been performed comparing open appendectomy (OA) to laparoscopic appendectomy (LA) in complicated appendicitis. A systematic review and meta-analysis in 2010 concluded LA is advantageous to OA with less surgical site sepsis in complicated appendicitis; however, the level of evidence is weak (level 3a). The aim of the study was to determine whether LA is safe in the treatment of complicated appendicitis. Primary outcome included all-cause mortality and procedure-related mortality; secondary outcomes included intra-operative duration, rates of wound sepsis and re-intervention, length of hospital stay and re-admission rates.

Methods

One hundred and fourteen patients were randomized prospectively to either OA or LA using a computer-generated blind method. Patients who were either less than 12 years of age, had previous abdominal surgery or were pregnant were excluded. A team of senior surgeons capable of doing both OA and LA performed all procedures.

Results

The intra-operative duration, the rate of wound sepsis, the number of re-operations, the length of hospital stay and the rate of re-admissions between the OA and LA groups did not differ statistically.

Conclusion

Laparoscopic appendectomy is safe in complicated appendicitis. Current Control Trials (ISRCTN92257749)

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Acknowledgments

This paper is make possible thanks to the diligent work performed by Hermina Tau. Her dedication to this paper is greatly appreciated.

Disclosures

John-Edwin Thomson, Deirdré Kruger, Christine Jann-Kruger, Akos Kiss, JAO Omoshoro-Jones, Thifheli Luvhengo, and Martin Brand have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Chris Hani Baragwanath Academic Hospital, Old Potch Road, Moreleta Park, Soweto, Johannesburg, 2013, South Africa

    John-Edwin Thomson, Christine Jann-Kruger, Akos Kiss, J. A. O. Omoshoro-Jones, Thifheli Luvhengo & Martin Brand

  2. Faculty of Health Sciences, University of the Witwatersrand, 9th Floor Medical School, 7 York Road, Johannesburg, 2193, South Africa

    John-Edwin Thomson, Deirdré Kruger, Christine Jann-Kruger, Akos Kiss, J. A. O. Omoshoro-Jones, Thifheli Luvhengo & Martin Brand

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  1. John-Edwin Thomson
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  2. Deirdré Kruger
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Correspondence to John-Edwin Thomson.

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Thomson, JE., Kruger, D., Jann-Kruger, C. et al. Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety. Surg Endosc 29, 2027–2032 (2015). https://doi.org/10.1007/s00464-014-3906-y

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  • DOI: https://doi.org/10.1007/s00464-014-3906-y

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