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Laparoscopic versus open surgery for suspected appendicitis.

Stefan Sauerland¹, Thomas Jaschinski, Edmund Am Neugebauer

¹Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Dillenburger Str. 27, Cologne, Germany, 51105.

The Cochrane Database of Systematic Reviews

|October 8, 2010

Summary

Laparoscopic appendectomy (LA) offers benefits like reduced wound infections and faster recovery compared to open appendectomy (OA). However, it has a slightly higher risk of intra-abdominal abscesses and longer surgery time. LA is generally recommended when feasible.

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Area of Science:

Surgical Innovation
Gastrointestinal Surgery
Evidence-Based Medicine

Background:

Laparoscopic surgery for acute appendicitis is increasingly proposed as an alternative to conventional open surgery.
The potential advantages of laparoscopic appendectomy (LA) over open appendectomy (OA) warrant a comprehensive comparison.

Purpose of the Study:

To systematically compare the diagnostic and therapeutic outcomes of laparoscopic versus conventional open appendectomy.
To evaluate the impact of diagnostic laparoscopy in reducing negative appendectomy rates.

Main Methods:

A systematic review and meta-analysis of randomized clinical trials comparing LA and OA.
Searches conducted across major databases including Cochrane Library, MEDLINE, EMBASE, LILACS, CNKI, and SciSearch.
Data extracted and analyzed using odds ratios (OR), relative risks (RR), and 95% confidence intervals (CI).

Main Results:

LA was associated with fewer wound infections (OR 0.43) but a higher incidence of intra-abdominal abscesses (OR 1.87) compared to OA.
LA resulted in reduced postoperative pain, shorter hospital stays (1.1 days), and earlier return to normal activities.
Diagnostic laparoscopy significantly reduced negative appendectomy rates, particularly in fertile women.

Conclusions:

Laparoscopic appendectomy (LA) offers advantages in recovery and wound complications, despite a slightly increased risk of abscesses and longer operative time.
The clinical relevance of some observed effects is small, and the quality of evidence is moderate.
LA is recommended for suspected appendicitis when feasible and affordable, especially for young, obese, and employed patients.