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Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy
J M Garbutt1, N J Soper, W D Shannon
1Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Surgical Laparoscopy & Endoscopy
|February 9, 1999
Summary
Laparoscopic appendectomy offers better patient outcomes than open surgery for acute appendicitis. This minimally invasive approach reduces recovery time and wound infections, despite a slightly longer operating time.
Area of Science:
- Surgical outcomes research
- Minimally invasive surgery
Background:
- Acute appendicitis is a common surgical emergency.
- Laparoscopic and open appendectomy are established treatment options.
- Comparative effectiveness of these procedures requires ongoing evaluation.
Purpose of the Study:
- To compare patient outcomes between laparoscopic and open appendectomy.
- To synthesize evidence from randomized controlled trials via meta-analysis.
Main Methods:
- Systematic literature search of MEDLINE, personal files, and meeting abstracts.
- Inclusion of 11 randomized controlled trials (RCTs) out of 21 identified.
- Meta-analysis using a random effects model to pool effect sizes.
Main Results:
- Laparoscopic appendectomy significantly reduced time to full functioning by 5.48 days (p < 0.001).
- Improved postoperative pain scores (1.19 points on VAS, p=0.014) and decreased wound infection risk (3.2%, p=0.009) were observed.
- Increased operative time (17.12 min, p < 0.0001) for laparoscopy; no significant differences in hospital stay, readmission, or abscess formation.
Conclusions:
- Laparoscopic appendectomy demonstrates superior patient outcomes compared to open surgery.
- Benefits include faster recovery and lower infection rates, outweighing the increased operative time.
- Evidence supports laparoscopic appendectomy as an effective treatment for acute appendicitis.