A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis.
OBJECTIVE
To determine if any significant differences exist between laparoscopic appendectomy (LA) and open appendectomy (OA).


METHODS
A meta-analysis of randomized controlled trials (RCTs) comparing LA to OA.


METHODS
An extensive literature search was conducted for appropriate articles published between January 1990 and March 1997. Articles were initially retrieved through MEDLINE with MeSH terms "appendicitis" or "appendectomy" and "laparoscopy". Additional methods included cross-referencing bibliographics of retrieved articles, hand searching abstracts from relevant meetings and consultation with a content expert.


METHODS
Only RCTs published in English in which patients had a preoperative diagnosis of acute appendicitis were included.


METHODS
The outcomes of interest included operating time, hospital stay, readmission rates, return to normal activity and complications. The Cochrane Collaboration Review Manager 3.0 was used to calculate odds ratios (OR), weighted mean differences (WMD) and 95% confidence intervals (CI). The random-effects model was used for statistical analysis.


RESULTS
Twelve trials met the inclusion criteria. Because there were insufficient data in some trials, operating time, hospitalization and return to work were assessed in only 8 trials. Mean operating time was significantly longer with LA (WMD 18.10 minutes, 95% CI 12.87 to 23.15 minutes). There were fewer wound infections in LA (OR 0.40, 95% CI 0.24 to 0.69), but no significant differences in intra-abdominal abscess rates (OR 1.94, 95% CI 0.68 to 5.58). There was no significant difference in the mean length of hospital stay (WMD -0.16 days, 95% CI -0.44 to 0.15 days) or readmission rates (OR 1.16, 95% CI 0.54 to 2.48). However, the return to normal activity was significantly earlier with LA (WMD -5.79 days, 95% CI -7.38 to -4.21 days). Sensitivity analyses did not affect the results.


CONCLUSIONS
This meta-analysis suggests that operating room time is significantly longer, hospital stay is unchanged but return to normal activities is significantly earlier with LA.
Temple
L K
LK
Department of Surgery, Mount Sinai Hospital, Toronto, Ont.
Litwin
D E
DE
McLeod
R S
RS
D018784:Abdominal Abscess / Q000209:etiology; D000041:Absenteeism; D000203:Activities of Daily Living; D000208:Acute Disease; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D016001:Confidence Intervals; D005260:Female; D006760:Hospitalization; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D010359:Patient Readmission; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome