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Ambulatory versus conventional laparoscopic appendectomy: a systematic review and meta-analysis
Mario Trejo-Avila1, Eduardo Cárdenas-Lailson2, Carlos Valenzuela-Salazar2
1Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, 4800 Calzada de Tlalpan, 14080, Mexico, Mexico. mario.trejo.avila@gmail.com.
International Journal of Colorectal Disease
|July 6, 2019
Summary
Ambulatory laparoscopic appendectomy (LA) shows reduced morbidity and readmission rates compared to conventional LA. While more high-quality studies are needed, current data suggest ambulatory LA is safe and feasible for acute appendicitis treatment.
Area of Science:
- Surgical Innovation
- Gastrointestinal Surgery
- Outpatient Procedures
Background:
- Ambulatory laparoscopic appendectomy (LA) is increasingly adopted.
- Patient selection, enhanced recovery pathways, and healthcare resource utilization drive this trend.
Purpose of the Study:
- To compare morbidity and readmission rates between ambulatory and conventional LA.
- Evaluate the safety and feasibility of outpatient LA for acute appendicitis.
Main Methods:
- Systematic literature search (PubMed, Embase, Cochrane, Web of Science) for studies from 2014-2018.
- Meta-analysis of 5 studies (7079 ambulatory LA, 6370 conventional LA patients).
- Comparison of complication and readmission events between groups.
Main Results:
- Significantly shorter length of stay in the ambulatory group (mean difference -15.63 h).
- Reduced pooled relative risk (RR) of overall morbidity (0.79) and readmission (0.72) in ambulatory LA.
- No significant difference in reoperation rates (RR 0.49).
Conclusions:
- Current data suggest ambulatory LA is safe and feasible.
- A lack of high-quality comparative studies limits definitive recommendations.
- Further research is warranted to solidify the benefits of outpatient appendectomy.
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