Systematic review of randomized controlled trials comparing laparoscopic with open appendicectomy

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Evidence-Based Medicine

Background:

• The efficacy of laparoscopic surgery for suspected appendicitis remains under debate.
• Numerous randomized controlled trials (RCTs) have been conducted, but consensus is lacking.

Purpose of the Study:

• To systematically review and synthesize evidence from RCTs comparing laparoscopic appendicectomy with open appendicectomy.
• To evaluate the safety and effectiveness of laparoscopic appendicectomy in managing appendicitis.

Main Methods:

• A systematic review of published RCTs comparing laparoscopic and open appendicectomy.
• Studies were identified via Medline, supplemented by manual searches of journals and abstracts.
• Data extraction and analysis followed predefined criteria.

Main Results:

• Ten RCTs were included; seven reported intention-to-treat analyses.
• Laparoscopic appendicectomy showed longer operating times (8-29 min) but reduced wound infection risk (OR 2.6).
• A minimal reduction in hospital stay and earlier return to normal activity were observed, though bias (e.g., lack of blinding) complicates interpretation.

Conclusions:

• Laparoscopic appendicectomy presents advantages, notably lower wound infection rates, with no significant increase in other complications.
• Prolonged operating time is a drawback, and bias in current studies necessitates caution.
• Future RCTs should prioritize blinding, adequate follow-up, and intention-to-treat analysis to minimize bias and enhance result reliability.