title: The incidence of intraabdominal abscess formation following laparoscopic appendicectomy in children: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Recent systematic reviews have suggested an increased incidence of intraabdominal abscess (IAA) formation following laparoscopic appendicectomy (LA) compared with the open approach (OA). As the majority of these analyses have focused on appendicectomy in adults, our aim was to review the evidence base for pediatric patients.
  
  
  METHODS
  We performed a comprehensive review of relevant studies published between 1990 and 2012. Specific inclusion and exclusion criteria were used to identify studies that investigated the incidence of IAA following LA and OA in pediatric patients. The primary outcome measure in the present meta-analysis was IAA formation, and secondary outcomes included wound infection (WI) and incidence of postoperative small bowel obstruction (SBO).
  
  
  RESULTS
  Sixty-six studies with a total of 22,060 pediatric patients were included: 56.5% OA and 43.5% LA. There was no overall difference in the incidence of IAA formation: 2.7% for OA (333/12,460) versus 2.9% for LA (282/9600) (P=.25). However, OA patients had a higher incidence of wound infection: 3.7% for OA (337/9228) versus 2.2% for LA (183/8154) (P<.001). Moreover, the incidence of SBO was lower in patients undergoing LA: 0.4% LA (86/5767) versus 1.5% (29/6840) (P<.001).
  
  
  CONCLUSIONS
  The IAA incidence is comparable in LA versus OA in pediatric patients. LA confers a significantly lower risk of other postoperative complications, including WI and SBO.
authors.affiliation: Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom. nataraja@doctors.org.uk
authors.forename: Ramesh M
authors.initials: RM
authors.lastname: Nataraja
authors.forename: Stavros P
authors.initials: SP
authors.lastname: Loukogeorgakis
authors.forename: William J
authors.initials: WJ
authors.lastname: Sherwood
authors.forename: Simon A
authors.initials: SA
authors.lastname: Clarke
authors.forename: Munther J
authors.initials: MJ
authors.lastname: Haddad
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology*; D001062:Appendectomy / Q000009:adverse effects*; D002648:Child; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology