Perforated appendicitis treated with laparoscopic appendicectomy or open appendicectomy: A meta-analysis.

Area of Science:

• General Surgery
• Gastrointestinal Surgery

Background:

• Perforated appendicitis (PA) is a serious condition requiring prompt surgical intervention.
• Laparoscopic appendicectomy (LA) and open appendicectomy (OA) are common surgical approaches.
• Comparative effectiveness of LA versus OA for PA requires further elucidation.

Purpose of the Study:

• To compare the outcomes of laparoscopic appendicectomy (LA) versus open appendicectomy (OA) in adult patients with perforated appendicitis (PA).
• To systematically review and meta-analyze existing evidence on the efficacy and safety of both surgical techniques for PA.

Main Methods:

• A comprehensive literature search was conducted in PubMed, Cochrane Library, and Embase up to January 2022.
• Inclusion criteria focused on studies comparing LA and OA for PA, with data extraction and quality assessment performed by two independent investigators.
• Dichotomous outcomes (e.g., intra-abdominal abscess, wound infection, complications) were analyzed using odds ratios (OR), and continuous outcomes (e.g., operative time, hospital stay) using weighted mean difference (WMD).

Main Results:

• The meta-analysis included three randomized controlled trials and 12 case-control studies.
• While intra-abdominal abscess rates were similar between LA and OA groups (OR: 1.28), LA demonstrated a significantly lower wound infection rate (OR: 0.38).
• Laparoscopic appendicectomy was associated with a shorter hospital stay (WMD: -1.43 days) and fewer overall complications compared to open appendicectomy (OR: 0.40).

Conclusions:

• Laparoscopic appendicectomy presents significant advantages for treating perforated appendicitis, leading to improved post-operative outcomes.
• Key benefits include a reduced incidence of wound infections, shorter hospital stays, and fewer complications.
• Further high-quality randomized controlled trials with large sample sizes are warranted to definitively establish the clinical benefits of LA for PA.