Laparoscopic vs conventional appendectomy--a meta-analysis of randomised controlled trials.
OBJECTIVE
To compare the effectiveness and safety of laparoscopic and conventional "open" appendectomy in the treatment of acute appendicitis.


METHODS
Meta-analysis of randomised controlled trials available by May 1998 that compared both techniques. Within each trial and for each outcome an effect size was calculated; the effect sizes were then pooled by a random-effects model.


RESULTS
We summarised outcome data of 2877 patients included in 28 trials. Operating time was +16 min (95% confidence interval +12-20 min) longer for laparoscopic appendectomy. Overall complication rates were comparable, but wound infections were definitely reduced after laparoscopy [rate difference -4.2%, (-2.3% to -6.1%)]. Intra-abdominal abscesses, however, occurred slightly more frequently [+0.9%, (-0.4% to +2.3%)]. Hospital stay after laparoscopic appendectomy was 15 h (8-23 h) shorter, and patients returned to full fitness or work 7 days (5-9 days) earlier. Pain intensity on day 1 was slightly less. Heterogeneity was present for some outcome measures due to methodological differences among the primary studies.


CONCLUSIONS
Laparoscopic appendectomy reduces wound infections and eases postoperative recovery. Nevertheless, the various differences among the primary studies and their partly flawed methodology make it difficult to generalise from these findings.
2nd Department of Surgery, University of Cologne, Germany.
S
S
Sauerland
R
R
Lefering
U
U
Holthausen
E A
EA
Neugebauer
D000208:Acute Disease; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome