title: Evidence to support the use of laparoscopic over open appendicectomy for obese individuals: a meta-analysis.
abstract: BACKGROUND
  Laparoscopic appendicectomy (LA) in the obese population has been controversial. A recent SAGES guideline and a Cochrane Review have suggested a benefit for LA over the open approach but did not provide supporting data. This study is the first systematic review and meta-analysis to compare the LA with open surgery in the obese population to provide a quantitative estimate of the relative benefits.
  
  
  METHODS
  A comprehensive search of the online databases identified seven retrospective and prospective randomized studies that contained sufficient data on obese patients. Analysis was based on intention-to-treat. We calculated pooled odds ratios (ORs) and 95 % confidence intervals using a random-effects model.
  
  
  RESULTS
  The LA group contained more females (43 vs. 32 %, p < 0.001), had fewer perforations (18 vs. 23 %; p < 0.001), and fewer overall complications (OR: 0.49; 95 % CI: 0.37-0.63), including fewer wound infections (OR: 0.34; 95 % CI: 0.18-0.66). There was no difference in the intra-abdominal abscess rate between the groups (OR: 0.99; 95 % CI: 0.29-3.37). The LA group had a shorter length of stay (2.46 vs. 3.63 days; p < 0.001) but a longer operation time (96 vs. 78 min, p < 0.001). There was no heterogeneity between the studies.
  
  
  CONCLUSIONS
  This meta-analysis of the current published data establishes the laparoscopic approach to appendicectomy as the preferred technique for the obese population, delivering a 50 % reduction in morbidity, with a 66 % reduction in wound infections and a significantly shorter inpatient hospital stay without increasing the intra-abdominal abscess rate.
authors.affiliation: Department of Surgery, Nepean Hospital, Penrith, NSW, Australia.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Woodham
authors.forename: Michael R
authors.initials: MR
authors.lastname: Cox
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
mesh_terms: D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009765:Obesity / Q000150:complications*