Open versus laparoscopic appendicectomy: a critical review.
BACKGROUND
The benefit of laparoscopic appendicectomy remains unclear. We have analysed available randomised studies comparing laparoscopic and open appendicectomy regarding their clinical pitfalls and statistical relevance.


METHODS
Thirty eight studies were analysed in terms of the following aspects: A. clinical problems (e.g., expertise of the surgeons, pre- and postoperative antibiotic treatment, definition of complications, blinding of outcomes) and B. statistical problems (e.g., definition of primary and secondary outcomes, power and sample size, statistical methods, confidence intervals, comparability of groups and studies).


RESULTS
Most of the studies have clinical and statistical pitfalls. The most important pitfalls are the uncertain expertise of the operating surgeons, blinding, and the exploratory nature of the studies. Our analysis aims at giving useful information for the appraisal of existing studies and the conduct of further studies. It also gives some preliminary results.


CONCLUSIONS
More than twenty years after Semm performed the first laparoscopic appendicectomy, it is necessary to clarify the superiority of laparoscopic or open appendectomy with well-defined, carefully designed randomised studies.
Kapischke
M
M
Department of General and Thoracic Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold Heller Strasse 07, D-24105 Kiel, Germany. mkapischke@web.de
Caliebe
A
A
Tepel
J
J
Schulz
T
T
Hedderich
J
J
D001062:Appendectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D016032:Randomized Controlled Trials as Topic