title: Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis.
abstract: BACKGROUND
  The goal of the present study was to critically review and identify the strength of available evidence in the literature on the use of laparoscopic appendectomy (LA) in complicated appendicitis (CA).
  
  
  METHODS
  The Cochrane Library and Controlled Trials Registry, MEDLINE (Ovid), PubMed, Web of knowledge, and SCOPUS databases were electronically searched, using the keywords "appendectomy," "laparoscopy," "appendicitis." "complicated appendicitis." "gangrenous appendicitis," "perforated appendicitis," with English language as a limit. Backward chaining was also employed. The NHS Public Health Resource Unit Critical Appraisal Skills Programme Tools were used for critical appraisal.
  
  
  RESULTS
  Twelve retrospective case-control studies were included in the review. Overall methodological quality was moderate to poor, with heterogeneity, absence of randomization and blinding, and presence of important methodological flaws. Meta-analysis showed that LA in CA has reduced surgical site infection (SSI) rates compared to open appendectomy (OA), odds ratio (OR) 0.23, 95% confidence intervals (CI): 0.14-0.37 (level 3a evidence), and no difference with regard to intra-abdominal abscess (IAA) complication rates OR: 1.02, 95% CI 0.56-1.86 (level 3a evidence).
  
  
  CONCLUSIONS
  When compared to OA, laparoscopic appendectomy is advantageous in CA with regard to SSIs, with no significant additional risk of IAA (level 3a evidence).
authors.affiliation: Department of General Surgery, Royal Oldham Hospital, Oldham, UK. g.markides@yahoo.co.uk
authors.forename: Georgios
authors.initials: G
authors.lastname: Markides
authors.forename: Daren
authors.initials: D
authors.lastname: Subar
authors.forename: Kallingal
authors.initials: K
authors.lastname: Riyad
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D016896:Treatment Outcome