Laparoscopy versus open appendectomy for elderly patients, a meta-analysis and systematic review

Area of Science:

• Surgical Innovation
• Geriatric Medicine
• Gastrointestinal Surgery

Background:

• Appendicitis in elderly patients presents a higher risk of postoperative complications.
• The optimal surgical approach, laparoscopy versus open appendectomy, remains debated for elderly patients.

Purpose of the Study:

• To compare the safety and efficacy of laparoscopic appendectomy (LA) versus open appendectomy (OA) in elderly patients.
• To analyze outcomes including mortality, complications, and length of stay.

Main Methods:

• A comprehensive literature search was conducted across major databases (MEDLINE, Embase, Cochrane, ClinicalTrials) in January 2019.
• Included studies compared LA and OA for appendicitis in elderly patients, extracting data on mortality, complications, wound infection, abscess, operating time, and hospital stay.
• Data analysis was performed using Review Manager 5.3.

Main Results:

• The analysis included 12 studies with a total of 349,558 patients (126,237 in LA, 213,201 in OA).
• Laparoscopic appendectomy showed significantly lower postoperative mortality (OR, 0.33; 95% CI, 0.28-0.39) and reduced complication and wound infection rates (OR, 0.65; 95% CI, 0.62-0.67 and OR, 0.27; 95% CI, 0.22-0.32, respectively).
• Intra-abdominal abscess rates were similar (OR, 0.44; 95% CI, 0.19-1.03), while surgery duration was longer (MD, 7.25; 95% CI, 3.13-11.36) but hospital stay was shorter (MD, -2.72; 95% CI, -3.31 to -2.13) with laparoscopy.

Conclusions:

• Laparoscopic appendectomy is a safe and feasible procedure for elderly patients with appendicitis.
• The technique is associated with decreased rates of mortality and postoperative morbidity.
• Laparoscopic appendectomy leads to shorter hospitalization periods compared to open surgery.