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Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis

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Abstract

Background

Currently, laparoscopic appendectomy (LA) provides a safe and effective alternative to open appendectomy (OA), but its use remains controversial. This study aimed to evaluate the efficiency and safety of LA through a metaanalysis.

Methods

Randomized controlled trials (RCTs) comparing LA and OA published between January 1992 and February 2010 were included in this study. Strict literature appraisal and data extraction were carried out independently by two reviewers. A metaanalysis then was performed to evaluate operative time, hospital cost, postoperative complications, length of analgesia, bowel function recovery, day liquid diet began, hospital stay, and return to work and normal activity.

Results

The metaanalysis comprised 25 RCTs involving 4,694 patients (2,220 LA and 2,474 OA cases). No significant differences were found between the LA and OA groups in terms of age, gender, body mass index (BMI), or type of appendiceal inflammation. Compared with OA, LA showed advantages of fewer postoperative complications (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.55–0.98; p = 0.04), less pain (length of analgesia: weighted mean difference [WMD], −0.53; 95% CI, −0.91 to −0.15; p = 0.007), earlier start of liquid diet (WMD, −0.51; 95% CI, −0.75 to −0.28; p < 0.0001), shorter hospital stay (WMD, −0.68; 95% CI, −1.02 to −0.35; p < 0.0001), and earlier return to work (WMD, −3.09; 95% CI, −5.22 to −0.97; p = 0.004) and normal activity (WMD, −4.73; 95% CI, −6.54 to −2.92; p < 0.00001), but a comparable hospital cost (WMD of LA/OA ratio, 0.11; 95% CI, −0.18 to 0.40; p = 0.47) and a longer operative time (WMD, 10.71; 95% CI, 6.76–14.66; p < 0.00001).

Conclusion

Despite the longer operative time, LA results in less postoperative pain, faster postoperative rehabilitation, a shorter hospital stay, and fewer postoperative complications than OA. Therefore, LA is worth recommending as an effective and safe procedure for acute appendicitis.

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Acknowledgment

The study was supported by the Medical Science Found of Guangdong Province (no. 2009078).

Disclosures

Bo Wei, Cui-Lling Qi, Tu-Feng Chen, Zong-Heng Zheng, Jiang-Long Huang, Bao-Guang Hu, and Hong-Bo Wei have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China

    Bo Wei, Tu-Feng Chen, Zong-Heng Zheng, Jiang-Long Huang, Bao-Guang Hu & Hong-Bo Wei

  2. Institute of Vascular Biology, Guangdong Pharmaceutical University, Guangzhou, 510006, China

    Cui-Lling Qi

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  1. Bo Wei
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Correspondence to Hong-Bo Wei.

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Bo Wei, Cui-Lliang Qi authors contributed equally to this work.

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Wei, B., Qi, CL., Chen, TF. et al. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc 25, 1199–1208 (2011). https://doi.org/10.1007/s00464-010-1344-z

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