title: Laparoscopic versus open appendectomy in children: a meta-analysis.
abstract: OBJECTIVE
  This study aims to use meta-analysis to compare laparoscopic and open appendectomy in a pediatric population.
  
  
  BACKGROUND
  Meta-analysis is a statistical tool that can be used to evaluate the literature in both qualitative and quantitative ways, accounting for variations in characteristics that can influence overall estimate of outcomes of interest. Meta-analysis of laparoscopic versus open appendectomy in a pediatric population has not previously been performed.
  
  
  METHODS
  Comparative studies published between 1992 and 2004 of laparoscopic versus open appendectomy in children were included. Endpoints were postoperative pyrexia, ileus, wound infection, intra-abdominal abscess formation, operative time, and postoperative hospital stay.
  
  
  RESULTS
  Twenty-three studies including 6477 children (43% laparoscopic, 57% open) were included. Wound infection was significantly reduced with laparoscopic versus open appendectomy (1.5% versus 5%; odds ratio [OR] = 0.45, 95% confidence interval [CI], 0.27-0.75), as was ileus (1.3% versus 2.8%; OR = 0.5, 95% CI, 0.29-0.86). Intra-abdominal abscess formation was more common following laparoscopic surgery, although this was not statistically significant. Subgroup analysis of randomized trials did not reveal significant difference between the 2 techniques in any of the 4 complications. Operative time was not significantly longer in the laparoscopic group, and postoperative stay was significantly shorter (weighted mean difference, -0.48; 95% CI, -0.65 to -0.31). Sensitivity analysis identified lowest heterogeneity when only randomized studies were considered, followed by prospective, recent, and finally large studies.
  
  
  CONCLUSIONS
  The results of this meta-analysis suggest that laparoscopic appendectomy in children reduces complications. However, we also see the need for further high-quality randomized trials comparing the 2 techniques, matched not only for age and sex but also for obesity and severity of appendicitis.
authors.affiliation: Imperial College of Science, Technology and Medicine, Department of Surgical Oncology and Technology, St. Mary's Hospital, London, UK.
authors.forename: Omer
authors.initials: O
authors.lastname: Aziz
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Paris P
authors.initials: PP
authors.lastname: Tekkis
authors.forename: Sanjay
authors.initials: S
authors.lastname: Purkayastha
authors.forename: James
authors.initials: J
authors.lastname: Haddow
authors.forename: Vitali
authors.initials: V
authors.lastname: Malinovski
authors.forename: Paraskevas
authors.initials: P
authors.lastname: Paraskeva
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D011183:Postoperative Complications; D013997:Time Factors