title: Systematic review of randomized controlled trials comparing laparoscopic with open appendicectomy.
abstract: BACKGROUND
  The role of laparoscopic surgery in the management of patients with suspected appendicitis is still debated despite a number of recent randomized controlled trials (RCTs).
  
  
  METHODS
  A systematic review has been undertaken of all published RCTs comparing laparoscopic appendicectomy with open appendicectomy. Studies were identified through Medline and supplemented with a manual search of relevant journals and meeting abstracts. Data were extracted and analysed according to predefined criteria.
  
  
  RESULTS
  Ten studies were identified, seven of which reported results on an intention-to-treat basis. Laparoscopic appendicectomy was associated with a longer operating time (8-29 min), a minimal reduction in hospital stay and, probably, an earlier return to normal activity. It was also associated with a reduced risk of wound infection (odds ratio 2.6) with no increase in other complications. However, bias, particularly resulting from lack of blinding, makes some of these results difficult to interpret.
  
  
  CONCLUSIONS
  Laparoscopic appendicectomy was associated with some advantages and no obvious disadvantages, apart from prolonged operating time. Future RCTs should be blinded to minimize bias, document adequate follow-up and analyse results on an intention-to-treat basis.
authors.affiliation: Department of Surgery, University of Otago Medical School, Dunedin, New Zealand.
authors.forename: J L
authors.initials: JL
authors.lastname: McCall
authors.forename: K
authors.initials: K
authors.lastname: Sharples
authors.forename: F
authors.initials: F
authors.lastname: Jadallah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic
chemical_list: D000700:Analgesics