Laparoscopic versus conventional appendectomy--a meta-analysis of randomized controlled trials

Area of Science:

• General Surgery
• Minimally Invasive Procedures
• Gastrointestinal Surgery

Background:

• The optimal surgical approach for acute appendicitis, open appendectomy (OA) versus laparoscopic appendectomy (LA), remains debated.
• Despite the widespread use of laparoscopic surgery, direct comparisons of OA and LA for appendicitis are essential.

Purpose of the Study:

• To compare the therapeutic effects and safety of laparoscopic appendectomy (LA) versus open appendectomy (OA) for acute appendicitis.
• To conduct a meta-analysis of randomized controlled trials (RCTs) evaluating these surgical techniques.

Main Methods:

• A meta-analysis of 44 RCTs involving 5292 patients published between 1990 and 2009.
• Comparison of key outcomes including operating time, hospital stay, pain, recovery, diet resumption, complications, and conversion rates.

Main Results:

• LA resulted in a longer operating time but significantly shorter hospital stays and earlier return to normal activity and diet.
• Postoperative pain was reduced with LA, and wound infection rates were significantly lower.
• LA showed a higher incidence of intra-abdominal abscess (IAA), though postoperative ileus, intraoperative bleeding, and urinary tract infections (UIT) were not significantly increased.

Conclusions:

• Laparoscopic appendectomy (LA) demonstrates clear advantages over open appendectomy (OA) in terms of recovery and complication rates.
• Despite a slight increase in IAA, LA is a safe procedure with superior therapeutic effects, justifying its widespread adoption.
• Trends suggest diminishing differences in operating times between LA and OA over the study period.