AimsTo review and compare the outcomes of laparoscopic (LA) versus open appendicectomy (OA) in complicated appendicitis in adult patients, eight years after the last literature review.MethodsThe PRISMA guidelines were adhered to. Pre-defined inclusion and exclusion criteria were used to search the PubMed, Scopus and Cochrane databases and extract relevant data. Methodological and quality assessment was undertaken with outcome meta-analysis and subgroup analyses of methodological quality, type of study and year of study. Assessment of clinical and statistical heterogeneity and publication bias was conducted.ResultsThree randomised control trials (RCTs) (154LA vs 155OA) and 23 case–control trials were included (2034LA vs 2096OA). Methodological quality was low to average but with low statistical heterogeneity. Risk of publication bias was low, and meta-regression indicated shorter length of hospital stay (LOS) in more recent studies, Q = 7.1, P = 0.007. In the combined analysis LA had significantly less surgical site infections OR = 0.30 (0.22,0.40); p < 0.00001] with reduced time to oral intake WMD = -0.98 (-1.09,-0.86); P < 0.00001] and LOS WMD = -3.49(-3.70,-3.29); p < 0.00001]. There was no significant difference in intra-abdominal abscess rates OR = 1.11(0.85,1.45); p = 0.43]. Operative time was longer during LA WMD = 10.51 (5.14,15.87); p = 0.0001] but did not reach statistical significance (p = 0.13) in the RCT subgroup analysis.ConclusionsLA appears to have significant benefits with improved morbidity compared to OA in complicated appendicitis (level of evidence II). |
