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Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis

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Abstract

Background

Acute appendicitis is a common condition in the pediatric population. In patients with uncomplicated appendicitis, laparoscopic appendectomy (LA) is preferred as compared to open appendectomy (OA). However, in patients with complicated appendicitis (CA), as defined as suppurative, gangrenous or perforated appendicitis, or appendicitis with periappendicular abscess formation, the decision to perform OA or LA remains unclear.

Methods

The PRISMA guidelines were adhered to. An electronic database search from 1997 to 2017 was performed using the Cochrane, Medline, PubMed, Scopus, Ovid, Embase, and Web of Knowledge databases. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Assessment of methodological and statistical heterogeneity, as well as publication bias of the included studies, was performed.

Results

Six randomized-control trials (296 LA versus 373 OA) and 33 case–control trials (3106 LA versus 4149 OA) were analyzed. Compared to OA, LA has a shorter length of stay (WMD = − 0.96, 95% CI − 1.47 to − 0.45) and a lower rate of surgical site infection (OR 0.37, 95% CI 0.25–0.54), although the rates of intraabdominal abscess formation were similar (OR 1.01, 95% CI 0.71–1.43). LA was also shown to have lower readmission rates, lower incidences of postoperative ileus or intestinal obstruction, lower incidence of reoperation, as well as a shorter time taken to oral intake. Operative time for OA was shorter than LA (WMD = 12.44, 95% CI 2.00–22.87).

Conclusion

While studies in the past have associated LA with higher rates of intraabdominal abscess in patients with CA, our meta-analysis has shown that they were similar. Considering this, together with other improved postoperative outcomes, LA should be the procedure of choice in pediatric patients presenting with CA.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road Level 11, Singapore, 119228, Singapore

    Zhi Xuan Low

  2. Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore

    Glenn Kunnath Bonney, Jimmy Bok Yan So & Jun Jie Ng

  3. Department of Paediatric Surgery, Khoo Teck Puat - National University Children’s Medical, Singapore, Singapore

    Dale Lincoln Loh

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Zhi Xuan Low, Glenn Kunnath Bonney, Jimmy Bok Yan So, Dale Lincoln Loh, and Jun Jie Ng have no conflicts of interest.

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Supplementary material 1 (DOCX 12 KB)

Supplementary material 2 (DOCX 36 KB)

Supplementary material 3 (DOCX 38 KB)

Supplementary material 4 (DOCX 25 KB)

Supplementary material 5 (DOCX 21 KB)

Supplementary Figure 6 Forest Plot of Postoperative Ileus or IO in the Meta-Analysis of LA versus OA (EPS 1211 KB)

Supplementary Figure 7 Forest Plot of Readmission in the Meta-Analysis of LA versus OA (EPS 907 KB)

Supplementary Figure 8 Forest Plot of Reoperation in the Meta-Analysis of LA versus OA (EPS 910 KB)

Supplementary Figure 9 Forest Plot of Percutaneous Intervention in the Meta-Analysis of LA versus OA (EPS 812 KB)

Supplementary Figure 10 Forest Plot of TTOI in the Meta-Analysis of LA versus OA (EPS 686 KB)

Supplementary Figure 11 Funnel Plot of IAA between LA and OA (EPS 77 KB)

Supplementary Figure 12 Funnel Plot of SSI between LA and OA (EPS 77 KB)

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Low, Z.X., Bonney, G.K., So, J.B.Y. et al. Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis. Surg Endosc 33, 4066–4077 (2019). https://doi.org/10.1007/s00464-019-06709-x

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