title: Laparoscopic appendicectomy in obese is associated with improvements in clinical outcome: systematic review.
abstract: BACKGROUND
  Obese patients with general surgical emergencies provide unique challenges to the emergency surgical teams. Acute appendicitis is the most common adult acute surgical emergency encountered in practice. This systematic review evaluates the role of laparoscopic appendicectomy in obese by comparing the outcomes of laparoscopic appendicectomy in obese versus non-obese and the laparoscopic versus open appendicectomy in obese patients.
  
  
  METHODS
  Relevant comparative studies were identified from the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PubMed (1990-2013). Primary outcomes evaluated were mortality, overall morbidity and duration of surgery. Secondary outcomes evaluated were superficial (superficial wound infection) and deep surgical site infection (intra-abdominal abscesses), conversion to open surgery, and cost of the procedure.
  
  
  RESULTS
  Seven retrospective cohort studies and one prospective randomized controlled trial met the inclusion criteria. There was no statistically significant difference in the primary and secondary outcomes between the obese and non-obese patients undergoing laparoscopic appendicectomy. Laparoscopic appendicectomy in obese patients is associated with reduced mortality (risk ratio [RR]: 0.19 (95% CI 0.12-0.30), reduced overall morbidity (RR: 0.49 (95% CI: 0.47-0.51)), reduced superficial wound infections (RR: 0.27 (95% CI 0.21-0.35)), shorter operating times and post-operative length of hospital stay, compared to open appendicectomy. Methodological quality of the included studies is low.
  
  
  CONCLUSIONS
  Laparoscopic appendicectomy appears to be a safer alternative approach to open surgery in obese adult patents. There is no significant difference in the outcomes between the obese and non-obese patients undergoing laparoscopic appendicectomy.
authors.affiliation: Department of General Surgery, Belfast Health and Social Care Trust, Belfast, UK. Electronic address: bobby.dasari@yahoo.com.
authors.forename: Bobby V M
authors.initials: BVM
authors.lastname: Dasari
authors.affiliation: Department of General Surgery, Belfast Health and Social Care Trust, Belfast, UK. Electronic address: jbaker04@hotmail.co.uk.
authors.forename: Jill
authors.initials: J
authors.lastname: Baker
authors.affiliation: Department of Surgery, Imperial College, London, UK. Electronic address: sheraz_markar@hotmail.com.
authors.forename: Sheraz
authors.initials: S
authors.lastname: Markar
authors.affiliation: Department of General Surgery, Belfast Health and Social Care Trust, Belfast, UK. Electronic address: keith.gardiner@hscni.net.
authors.forename: Keith
authors.initials: K
authors.lastname: Gardiner
mesh_terms: D000208:Acute Disease; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D009765:Obesity / Q000150:complications*; D061646:Operative Time; D011184:Postoperative Period; D013530:Surgical Wound Infection / Q000209:etiology
keywords: Appendicectomy; Emergency; Laparoscopy; Meta-analysis; Obese; Systematic review