title: Laparoscopic versus open appendicectomy in obese patients.
abstract: BACKGROUND
  Although there appears to be no outright benefit of laparoscopic versus open surgery for acute appendicitis in the general population, it has been suggested that in obese patients a laparoscopic approach may offer more conclusive gains. The aim of this pooled analysis of comparative studies was to evaluate clinical outcome following laparoscopic and open appendicectomy in the obese population.
  
  
  METHODS
  A systematic literature search of MEDLINE, Embase, Web of Science and the Cochrane Library databases was performed. Primary outcomes were length of operation (min) and length of hospital stay (days). Secondary outcomes were presence of post-operative complications, wound and intra-abdominal complications. Weighted mean differences were calculated to assess the size of the effect of laparoscopic appendicectomy on continuous variables and Pooled odds ratio were calculated for discrete variables.
  
  
  RESULTS
  2309 appendicectomies were included in this analysis, 1122 laparoscopic and 1187 open appendicectomies. Analysis of primary outcome measures revealed a shorter length of post-operative stay associated with laparoscopic appendicectomy (weighted mean difference = -1.26; 95% confidence interval = -2.36 to -0.16; p = 0.02). There was no significant difference between the groups for length of operation, post-operative complications, intra-abdominal or wound complications.
  
  
  CONCLUSIONS
  The results of this pooled analysis indicate that laparoscopic appendicectomy may be beneficial in the obese population with a shorter length of hospital stay, and a similar incidence of post-operative complications.
authors.affiliation: General Surgical Department, Kingston Hospital NHS Trust, Galworthy Road, Kingston upon Thames KT2 7QB, United Kingdom. sherz_markar@hotmail.com
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.forename: Vishal
authors.initials: V
authors.lastname: Venkat-Raman
authors.forename: Alison
authors.initials: A
authors.lastname: Ho
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: James
authors.initials: J
authors.lastname: Kinross
authors.forename: Jessica
authors.initials: J
authors.lastname: Evans
authors.forename: Ian
authors.initials: I
authors.lastname: Bloom
mesh_terms: D000208:Acute Disease; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D009765:Obesity / Q000150:complications*; D016896:Treatment Outcome