Abstract
Objective: Despite many randomized controlled trials, it is still not clear whether open appendectomy or laparoscopic appendectomy is the most appropriate surgical approach to acute Appendicitis. It is also widely recognized that laparoscopic removal of appendectomy is a well-established procedure with good outcomes. The aim of this study was to evaluate the short-term results of open appendectomy versus laparoscopic appendectomy in adults. Methods: We undertook a meta-analysis of randomized controlled trials comparing open appendectomy and laparoscopic appendectomy in adults. We searched the PubMed, EMBASE, and Cochrane Library databases up to June 20, 2017. Calculations were made of the effect sizes of short-term outcomes: wound infection, intra-abdominal abscess, postoperative complications, peritonitis, postoperative ileus, urinary tract infection, and reoperation, the effect sizes were then pooled by a fixed or random-effects model. Results: Twenty-nine randomized controlled trials with 4311 participants were included. Meta-analysis of the available literature demonstrated that laparoscopic appendectomy in adults was associated with lower incidence of wound infection (OR=0.54, 95% CI: 0.42-0.70, P<0.00001), and fewer postoperative complications (OR=0.77, 95% CI: 0.66-0.90, P= 0.001). Further analysis did not reveal significant differences between the two surgery approaches in intra-abdominal abscess, peritonitis, postoperative ileus, urinary tract infection, and reoperation in adults. Conclusion: Laparoscopic appendectomy reduces wound infections and postoperative complications in the treatment of adult acute appendicitis. Laparoscopic appendectomy is worth recommending as an effective and safe procedure for acute appendicitis in adults.
Highlights
Appendicitis is the most common cause for acute abdominal pain with a life-time incidence between 6.7% and 8.6% [1,2]
The evolution of endoscopic surgery led to the idea of performing appendectomy via laparoscopy; this was first described by Semm in 1983 [5]
A fixed-effects model was used because there was no significantly heterogeneity between the two groups (I2=49%, P=0.003), and the results demonstrated that laparoscopic appendectomy was associated with a significantly reduced incidence of postoperative complications (OR=0.77, 95% confidence interval (CI): 0.66-0.90, P=0.001) (Figure 5)
Summary
Appendicitis is the most common cause for acute abdominal pain with a life-time incidence between 6.7% and 8.6% [1,2]. It is the most common emergency in abdominal surgery [3]. Performed through the right lower quadrant incision was first described in 1894. It has become the standard treatment of choice for acute appendicitis, remaining mainly unchanged for 100 years due to its favorable efficacy and safety. The evolution of endoscopic surgery led to the idea of performing appendectomy via laparoscopy; this was first described by Semm in 1983 [5]. There remains a continuing controversy in the literature regarding the most appropriate method of removing the inflamed appendix
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