Needlescopic versus laparoscopic appendectomy: a systematic review.
BACKGROUND
Needlescopic appendectomies (NA) have been performed since the 1990s. We sought to systematically analyze trials comparing NA with laparoscopic appendectomies (LA) in the management of appendicitis.


METHODS
We performed a systematic review of the literature. We compared and analyzed clinical trials on NA and LA to generate summative data expressed as standardized mean differences (SMD).


RESULTS
Of 5 retrieved trials from the electronic database 2 trials involving 412 patients met our inclusion criteria. In the fixed-effects models, NA took longer than LA, and this time difference was statistically significant: SMD 0.20 min, 95% confidence interval 0.01-0.40, p = 0.030, z(1) = 2.09. In both fixed-and random-effects models, the difference in total hospital stay and in perioperative complications between the NA and LA groups were nonsignificant. Furthermore, in both fixed-and random-effects models, NA was associated with a higher conversion rate to open appendectomy than LA. There was no heterogeneity between the trials (Q = 0.34, p = 0.55).


CONCLUSIONS
Needlescopic appendectomy can be a safe and effective procedure for the management of appendicitis. It is comparable to LA in terms of hospital stay and perioperative complications. However, NA is associated with a longer duration of surgery and a higher conversion rate, indicating technical challenges of the procedure. Before recommending routine use of the needlescopic technique for appendectomy, a major multicentre randomized controlled trial is necessary.
Sajid
Muhammad Shafique
MS
Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, UK. surgeon1wrh@hotmail.com
Khan
Munir Ahmad
MA
Cheek
Elizabeth
E
Baig
Mirza Khurrum
MK
D001062:Appendectomy / Q000295:instrumentation* / Q000379:methods*; D001064:Appendicitis / Q000601:surgery; D002986:Clinical Trials as Topic; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D011183:Postoperative Complications