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The Risk of Adhesive Bowel Obstruction in Children With Appendicitis: A Systematic Review
Neel Doshi1, Soham Bandyopadhyay1, Madeline Green1
1University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
Insights
Complicated appendicitis nearly doubles the risk of adhesive bowel obstruction in children. Surgical approach (laparoscopic vs. open) does not significantly alter this risk.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes Research
Background:
- Complicated appendicitis presents a higher risk of postoperative complications, notably adhesive bowel obstruction.
- Understanding the incidence of adhesive bowel obstruction in pediatric appendicitis is crucial for patient management.
- The influence of surgical approach on obstruction rates requires further investigation.
Approach:
- A systematic literature search adhering to PRISMA guidelines was performed across major databases (MEDLINE, Embase, Cochrane Library).
- Studies published between 1998 and 2022 focusing on pediatric appendicectomy and adhesive bowel obstruction were included.
- The study protocol was registered on PROSPERO (ID CRD42022309769).
Key Points:
- Pooled analysis of 6 studies (58,962 cases) indicated a near two-fold increase in small bowel obstruction (SBO) incidence with complicated appendicitis (OR 2.02).
- Analysis of 10 studies (62,433 cases) found no significant difference in SBO rates between open and laparoscopic approaches for complex appendicitis (OR 0.93).
- The evidence suggests complicated appendicitis is a significant risk factor for adhesive bowel obstruction.
Conclusions:
- Complex appendicitis is associated with a two-fold increase in adhesive bowel obstruction rates.
- While laparoscopic surgery offers cosmetic benefits, its superiority in reducing adhesive bowel obstruction risk is not conclusively supported by current evidence.
- Surgical expertise should be prioritized over the approach (laparoscopic vs. open) in managing complex appendicitis to mitigate obstruction risks.
Objective:
Complicated appendicitis is associated with a higher risk of postoperative complications, including adhesive bowel obstruction. The aim of this meta-analysis is to investigate the difference in rates of postoperative bowel obstruction in paediatric patients with complicated versus simple appendicitis and whether this is influenced by the surgical approach.
Methods:
A systematic literature search following PRISMA guidelines was conducted using MEDLINE, Embase and Cochrane Library for studies that analysed incidence of adhesive bowel obstruction in paediatric patients after appendicectomy. Studies from 1998 to 2022 were included in analysis. The study protocol was registered on PROSPERO (ID CRD42022309769).
Results:
Pooled analysis of 6 studies with low risk of bias and adequate follow up periods, considering 58,962 cases of appendicectomy, revealed complex appendicitis was associated with a near two-fold increase in incidence of SBO (pooled odds ratio 2.02 (95% CI 1.35-2.69)). Interestingly, a similar pooled analysis of 10 studies, considering 62,433 cases of appendicectomy, revealed no significant difference between open and laparoscopic management of complex appendicitis (pooled odds ratio 0.93 (95% CI 0.24 to 1.62)).
Conclusion:
Complex appendicitis is associated with a two-fold increase in the rates of adhesive bowel obstruction. Whilst there are cosmetic advantages of a laparoscopic approach, surgical expertise should be favoured in decision making relating to surgical approach (laparoscopic versus open) as the evidence for a laparoscopic approach reducing risks of adhesive bowel obstruction is not convincing.
Level Of Evidence:
Level II.
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