Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis.
BACKGROUND
Currently, laparoscopic appendectomy (LA) provides a safe and effective alternative to open appendectomy (OA), but its use remains controversial. This study aimed to evaluate the efficiency and safety of LA through a metaanalysis.


METHODS
Randomized controlled trials (RCTs) comparing LA and OA published between January 1992 and February 2010 were included in this study. Strict literature appraisal and data extraction were carried out independently by two reviewers. A metaanalysis then was performed to evaluate operative time, hospital cost, postoperative complications, length of analgesia, bowel function recovery, day liquid diet began, hospital stay, and return to work and normal activity.


RESULTS
The metaanalysis comprised 25 RCTs involving 4,694 patients (2,220 LA and 2,474 OA cases). No significant differences were found between the LA and OA groups in terms of age, gender, body mass index (BMI), or type of appendiceal inflammation. Compared with OA, LA showed advantages of fewer postoperative complications (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.55-0.98; p = 0.04), less pain (length of analgesia: weighted mean difference [WMD], -0.53; 95% CI, -0.91 to -0.15; p = 0.007), earlier start of liquid diet (WMD, -0.51; 95% CI, -0.75 to -0.28; p < 0.0001), shorter hospital stay (WMD, -0.68; 95% CI, -1.02 to -0.35; p < 0.0001), and earlier return to work (WMD, -3.09; 95% CI, -5.22 to -0.97; p = 0.004) and normal activity (WMD, -4.73; 95% CI, -6.54 to -2.92; p < 0.00001), but a comparable hospital cost (WMD of LA/OA ratio, 0.11; 95% CI, -0.18 to 0.40; p = 0.47) and a longer operative time (WMD, 10.71; 95% CI, 6.76-14.66; p < 0.00001).


CONCLUSIONS
Despite the longer operative time, LA results in less postoperative pain, faster postoperative rehabilitation, a shorter hospital stay, and fewer postoperative complications than OA. Therefore, LA is worth recommending as an effective and safe procedure for acute appendicitis.
Wei
Bo
B
Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Qi
Cui-Lling
CL
Chen
Tu-Feng
TF
Zheng
Zong-Heng
ZH
Huang
Jiang-Long
JL
Hu
Bao-Guang
BG
Wei
Hong-Bo
HB
D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data; D004032:Diet; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007813:Laparotomy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome